New York, N.Y.; and Boston, Mass. From the Institute of Reconstructive Plastic Surgery, New York University Medical Center, and Brigham and Women's Hospital.
Plast Reconstr Surg. 2013 Oct;132(4):945-954. doi: 10.1097/PRS.0b013e31829f4aa7.
The purpose of this study was to characterize soft-tissue profile changes following Le Fort III (midface) distraction in growing patients with syndromic craniosynostosis.
The cohort consisted of 20 syndromic patients who underwent Le Fort III osteotomy with midface advancement using a rigid external distraction device. The mean age at surgery was 5.7 years (range, 3 to 12.5 years). Lateral cephalograms were obtained preoperatively (time 1), after distraction device removal (time 2), and 1 year after distraction (time 3). Ten skeletal hard-tissue and 11 soft-tissue profile landmarks were identified and digitized at time points 1, 2, and 3. The x and y displacement of each landmark was studied to determine the ratios for soft- to hard-tissue change.
The horizontal ratio of soft- to hard-tissue change for nasal dorsum to orbitale was 0.73:1 and the soft-tissue tip of nose to the anterior nasal spine was 0.86:1. The horizontal ratio of soft-tissue A point to hard-tissue A point was 0.88:1. The horizontal ratio of the upper lip position to the labial surface of maxillary incisor was 0.88:1. The ratio for nasal tip elevation to the anterior nasal spine advancement was 0.27:1.
The result of this study supported the hypothesis that there exists a linear relationship between soft- and hard-tissue changes in the horizontal direction for the midface landmarks following Le Fort III distraction. However, there was a nonlinear relationship between soft- and hard-tissue changes in the vertical direction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
本研究的目的是描述综合征型颅缝早闭患者行 Le Fort III（面中部）牵张术后软组织侧貌的变化特征。
该队列包括 20 例综合征型患者，他们接受了 Le Fort III 截骨术和使用刚性外部牵张器的面中部推进术。手术时的平均年龄为 5.7 岁（范围 3 至 12.5 岁）。在术前（时间 1）、牵张器去除后（时间 2）和牵张 1 年后（时间 3）获得侧位头颅定位片。在时间点 1、2 和 3 识别并数字化了 10 个骨骼硬组织和 11 个软组织侧貌标志点。研究了每个标志点的 x 和 y 位移，以确定软组织与硬组织变化的比值。
鼻背到眶下点的软组织与硬组织的水平比值为 0.73:1，鼻尖到前鼻棘的软组织与硬组织的水平比值为 0.86:1。软组织 A 点与硬组织 A 点的水平比值为 0.88:1。上唇位置与上颌切牙唇面的水平比值为 0.88:1。鼻尖抬高与前鼻棘前徙的比值为 0.27:1。
本研究的结果支持以下假设，即在 Le Fort III 牵张术后，面中部标志点的水平方向上，软组织和硬组织之间存在线性关系。然而，在垂直方向上，软组织和硬组织之间存在非线性关系。
临床问题/证据水平：治疗性，IV 级。
