Hopper Richard A
Division of Pediatric Plastic Surgery, Craniofacial Center, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.
Curr Opin Otolaryngol Head Neck Surg. 2012 Aug;20(4):298-303. doi: 10.1097/MOO.0b013e3283543a43.
Syndromic craniofacial dysostosis remains one of the most challenging diagnoses in congenital craniomaxillofacial surgery. Distraction osteogenesis has held the promise of greater facial movements with improved stability, less morbidity and more favorable functional and esthetic outcomes. Current literature is starting to determine whether this promise is being fulfilled.
The current trend in the literature is increasing indications for distraction in treating syndromic synostosis. Posterior vault, anterior vault, early monobloc and segmental Lefort distraction techniques are being advocated as alternatives to traditional surgeries. Outcome analysis of distraction techniques is becoming more common, especially in the assessment of obstructive sleep apnea and advancement stability.
Distraction osteogenesis has challenged, and in many centers modified, the treatment algorithms for craniofacial dysostoses that had been based on traditional osteotomy techniques. In some cases, distraction osteogenesis has encouraged earlier, more aggressive surgeries; in others, it has served as a temporizing measure to allow subsequent traditional surgeries to be performed at a more favorable age. As craniofacial distraction osteogenesis evolves and we become more critical in our outcome analysis, we may find more favorable long-term results compared with traditional techniques in aspects such as premature aging, bone healing and degree of advancement.
综合征性颅面骨发育不全仍然是先天性颅颌面外科中最具挑战性的诊断之一。牵张成骨有望实现更大的面部活动度，同时提高稳定性、降低发病率，并带来更良好的功能和美学效果。当前的文献开始探讨这一前景是否正在实现。
文献中的当前趋势是，治疗综合征性颅缝早闭时牵张的适应证不断增加。后颅穹窿、前颅穹窿、早期整块和节段性勒福氏牵张技术被倡导作为传统手术的替代方法。牵张技术的结果分析越来越普遍，尤其是在阻塞性睡眠呼吸暂停和前移稳定性的评估方面。
牵张成骨对基于传统截骨技术的颅面骨发育不全治疗算法提出了挑战，并且在许多中心对其进行了改进。在某些情况下，牵张成骨促使更早、更积极的手术；而在其他情况下，它作为一种临时措施，以便后续能在更合适的年龄进行传统手术。随着颅面牵张成骨的发展，并且我们在结果分析中更加严格，我们可能会发现在诸如过早衰老、骨愈合和前移程度等方面，与传统技术相比有更良好的长期效果。
