New York, N.Y. From The Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center.
Plast Reconstr Surg. 2012 Jan;129(1):234-242. doi: 10.1097/PRS.0b013e3182362a2f.
Patients with syndromic craniosynostosis and midface hypoplasia are often treated with Le Fort III advancement. The authors present four patients with extraordinarily long-term follow-up (in excess of 20 years).
An institutional review board-approved retrospective chart review was performed on all patients with syndromic craniofacial synostosis who underwent Le Fort III advancement. Patients with greater than 20 years of cephalometric and photographic records were identified. Lateral cephalograms were obtained preoperatively, immediately postoperatively, at 1-year follow-up, and at long-term follow-up. Cephalograms were traced, digitized, and averaged. Fifty cephalometric landmarks were identified for serial measurements.
Of the four patients identified, one had Apert syndrome and three had Crouzon syndrome. Average age at the time of Le Fort III advancements was 11 years (range, 4 to 20 years). Average length of postoperative follow-up was 25 years (± 5 years). No patient had significant anterior midfacial growth following Le Fort III advancement. Both young patients (<10 years) had substantial vertical inferior midfacial growth after advancement.
These data demonstrate that the Le Fort III segment of children with syndromic craniosynostosis does not grow significantly forward. Moreover, the traditional Le Fort III osteotomy does not provide the amount of midface advancement necessary to avoid phenotypic recidivism in these syndromic patients. This study also suggests that patients undergoing Le Fort III advancement appear to have zygomatic effacement and ptosis of the overlying soft tissue with deepening of the facial folds; collectively, it is suggested that these changes give the appearance of accelerated facial aging.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
患有综合征性颅缝早闭和中面部发育不全的患者通常接受 Le Fort III 推进术治疗。作者介绍了 4 例具有超长随访期（超过 20 年）的患者。
对所有接受 Le Fort III 推进术的综合征性颅面骨缝早闭患者进行机构审查委员会批准的回顾性图表审查。确定了具有超过 20 年的头影测量和照片记录的患者。术前、术后即刻、1 年随访和长期随访时获得侧位头颅侧位片。对头颅侧位片进行追踪、数字化并取平均值。确定了 50 个头影测量标志点进行连续测量。
在所确定的 4 例患者中，1 例患有 Apert 综合征，3 例患有 Crouzon 综合征。Le Fort III 推进术时的平均年龄为 11 岁（范围，4-20 岁）。术后随访平均时间为 25 年（±5 年）。没有患者在 Le Fort III 推进术后出现明显的前中面部生长。两个年轻患者（<10 岁）在推进术后有大量的垂直下中面部生长。
这些数据表明，综合征性颅缝早闭儿童的 Le Fort III 段向前生长不明显。此外，传统的 Le Fort III 截骨术不能提供足够的中面部推进量，以避免这些综合征患者的表型复发。本研究还表明，接受 Le Fort III 推进术的患者似乎存在颧骨凹陷和上方软组织下垂，导致面部褶皱加深；总的来说，这些变化使患者看起来面部衰老加速。
临床问题/证据水平：治疗，V。
