Dai Jiewen, Wang Xudong, Yu Hongbo, Cheng Jie, Yuan Hao, Gui Haijun, Shen Shunyao, Shen Guofang
Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, People’s Republic of China.
J Craniofac Surg. 2012 Sep;23(5):1391-5. doi: 10.1097/SCS.0b013e3182565a5d.
Le Fort III osteotomy was usually applied to correct midface hypoplasia in Apert syndrome, and various surgical modifications have been developed in recent years. In this article, we reported the simultaneous Le Fort I, II, and III osteotomies for segmental advancement of midface deficiency involving nasal bones, zygoma, inferior orbital rims, and maxilla in an adult Chinese patient with Apert syndrome. To achieve the ideal advancement of different parts of midface simultaneously, we divided the midface into 4 segments, including nasal bone combined with upper portion of maxilla, lower portion of maxilla, and left and right zygoma, with simultaneous Le Fort I, Le Fort II, and Le Fort III osteotomies, and each segment was repositioned as required respectively to obtain ideal facial aesthetics and favorable occlusion. The long-term stability of bony segment advancements also was observed during 7-year follow-up. Compared with segmental distraction osteogenesis or multiple-stage surgery, which mainly applied to younger patients with more severe midface hypoplasia, this single-stage strategy offered a reliable surgical alternative for treating adult patient with midface hypoplasia that should be corrected in different levels.
勒福Ⅲ型截骨术通常用于矫正阿佩尔综合征中的面中部发育不全，近年来已开发出各种手术改良方法。在本文中，我们报告了对一名成年中国阿佩尔综合征患者进行同时性勒福Ⅰ型、Ⅱ型和Ⅲ型截骨术，以分段推进涉及鼻骨、颧骨、眶下缘和上颌骨的面中部缺损。为了同时实现面中部不同部位的理想推进，我们将面中部分为4个节段，包括鼻骨与上颌骨上部、上颌骨下部以及左右颧骨，通过同时进行勒福Ⅰ型、Ⅱ型和Ⅲ型截骨术，每个节段分别根据需要重新定位，以获得理想的面部美学效果和良好的咬合关系。在7年的随访中还观察了骨段推进的长期稳定性。与主要应用于面中部发育不全更严重的年轻患者的分段牵张成骨术或多阶段手术相比，这种单阶段策略为治疗不同程度需要矫正的面中部发育不全成年患者提供了一种可靠的手术选择。
