Zemann Wolfgang, Pichelmayer Margit
Department of Oral and Maxillofacial Surgery, Medical University Graz, Graz, Austria.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Jun;111(6):688-92. doi: 10.1016/j.tripleo.2010.08.002. Epub 2010 Nov 4.
Alveolar clefts are commonly closed by a bone grafting procedure. In cases of wide clefts the deficiency of soft tissue in the cleft area may lead to wound dehiscence and loss of the bony graft. Segmental maxillary bony transfer has been mentioned to be useful in such cases. Standard distraction devices allow unidirectional movement of the transported segment. Ideally the distraction should strictly follow the dental arch. The aim of this study was to analyze distraction devices that were adapted to the individual clinical situation of the patients. The goal was to achieve a distraction strictly parallel to the dental arch.
Six children with unilateral clefts of lip, palate, and alveolus between 12 and 13 years of age were included in the study. The width of the cleft was between 7 and 19 mm. Dental cast models were used to manufacture individual distraction devices that should allow a segmental bony transport strictly parallel to the dental arch. Segmental osteotomy was performed under general anesthesia. Distraction was started 5 days after surgery. All distracters were tooth fixed but supported by palatal inserted orthodontic miniscrews.
In all patients, a closure of the alveolar cleft was achieved. Two patients required additional bone grafting after the distraction procedure. The distraction was strictly parallel to the dental arch in all cases. In 1 case a slight cranial displacement of the transported maxillary segment could be noticed, leading to minor modifications of the following distractors.
Distraction osteogenesis is a proper method to close wide alveolar clefts. Linear segmental transport is required in the posterior part of the dental arch, whereas in the frontal part the bony transport should run strictly parallel to the dental arch. An exact guided segmental transport may reduce the postoperative orthodontic complexity.
牙槽嵴裂通常通过骨移植手术闭合。在宽裂的情况下，裂区软组织不足可能导致伤口裂开和骨移植失败。节段性上颌骨骨转移已被提及在此类情况下有用。标准牵张装置允许被转移节段单向移动。理想情况下，牵张应严格遵循牙弓。本研究的目的是分析适应患者个体临床情况的牵张装置。目标是实现与牙弓严格平行的牵张。
本研究纳入了6名年龄在12至13岁之间的单侧唇、腭裂和牙槽嵴裂患儿。裂宽在7至19毫米之间。使用石膏模型制作个体牵张装置，该装置应允许节段性骨转移严格平行于牙弓。在全身麻醉下进行节段性截骨术。术后5天开始牵张。所有牵张器均固定于牙齿，但由腭部植入的正畸微螺钉支撑。
所有患者的牙槽嵴裂均实现闭合。2名患者在牵张手术后需要额外的骨移植。所有病例中的牵张均严格平行于牙弓。在1例中，可注意到被转移的上颌节段有轻微的颅骨移位，导致后续牵张器有轻微调整。
牵张成骨是闭合宽牙槽嵴裂的一种合适方法。在牙弓后部需要线性节段性转移，而在前部，骨转移应严格平行于牙弓。精确的引导节段性转移可降低术后正畸的复杂性。
