Private Practice, Oral and Maxillofacial Prosthodontist and Implantologist, Tehran, Iran.
J Craniomaxillofac Surg. 2013 Jul;41(5):397-402. doi: 10.1016/j.jcms.2012.11.004. Epub 2012 Dec 4.
Many Freeman-Sheldon syndrome patients suffer from extensive microstomia resulting in possible inhibition of dental and skeletal development as well as difficulties in eating, speech and dental hygiene. Oral commissure contraction treatments vary from patient education to complicated surgical and/or prosthetic treatments, but recurrence is often described. This article reports on a combined surgical and non-surgical approach in order to increase maximum mouth opening and maintain the result of the surgery.
The patient underwent bilateral commissuroplasty using 2 rhomboid flaps for each side. After two steps of intraoral and perioral tissue impression taking, a master cast was poured and a retractor was fabricated from thermoplastic material. The patient was encouraged to wear the retractor the entire day and night except at meal times.
After surgery maximum mouth opening was increased from 20 mm to 37 mm and remained the same six months after the surgery. Psychosocial factors were improved and the patient was satisfied with the results of her treatment.
The use of bilateral commissuroplasty in combination with this customized dynamic oral commissure retractor may be applicable in other syndromic patients with a small oral commissure and also in patients with circumoral burns.
许多弗曼-谢尔登综合征患者患有广泛的小口畸形，这可能导致牙齿和骨骼发育受阻，以及进食、言语和口腔卫生困难。口裂收缩的治疗方法从患者教育到复杂的手术和/或义齿治疗都有，但常描述有复发。本文报告了一种联合手术和非手术方法，以增加最大张口度并维持手术效果。
患者接受了双侧口角成形术，每侧使用 2 个菱形皮瓣。在进行了两步口腔内和口周组织印模制取后，制作了一个主模型，并使用热塑性材料制作了一个牵开器。患者被鼓励全天佩戴牵开器，除了进食时间。
手术后，最大张口度从 20 毫米增加到 37 毫米，手术后 6 个月仍保持相同。社会心理因素得到改善，患者对治疗效果满意。
双侧口角成形术结合这种定制的动态口裂牵开器，可能适用于其他小口畸形的综合征患者，也适用于口周烧伤的患者。
