Mitsukawa Nobuyuki, Saiga Atsuomi, Morishita Tadashi, Satoh Kaneshige
Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan.
Department of Plastic and Reconstructive Surgery, St. Mary's Hospital, Fukuoka, Japan.
J Craniomaxillofac Surg. 2014 Jul;42(5):623-8. doi: 10.1016/j.jcms.2013.09.003. Epub 2013 Oct 14.
Patients with bilateral cleft lips and palates have premaxillary protrusion and characteristic jaw deformities involving three-dimensional malposition of the premaxilla and bilateral maxillary bone segments. This study examined patients with bilateral cleft lips and palates who had deviation and hypoplasia of the premaxillas and bilateral maxillary segments. Before bone grafting, the patients were treated with special distraction performed separately for each bone segment using a halo-type external device. This report describes this novel treatment method which produced good results.
The subjects were five patients with severe jaw deformities due to bilateral cleft lip and palate. They were treated with maxillary Le Fort I osteotomy and subsequent distraction performed separately for each bone segment using a halo device. In three of five patients, premaxillary osteotomy was not performed, and osteotomy and distraction were performed only for the right and left lateral segments with severe hypoplasia.
All patients achieved distraction close to the desired amount. The widths of the alveolar clefts were narrowed, and satisfactory occlusion and maxillary arch form were achieved. After the surgery, three of five patients underwent bone grafting for bilateral alveolar cleft defects and the bone graft survival was satisfactory.
This method had many benefits, including narrowing of alveolar clefts, improvement of maxillary hypoplasia, and achievement of a good maxillary arch form. In addition, subsequent bone grafting for alveolar cleft defects was beneficial, dental prostheses were unnecessary, and frequency of surgery and surgical invasiveness were reduced. This method is a good surgical procedure that should be considered for patients with bilateral cleft lips and palates who have premaxillary protrusion and hypoplasia of the right and left lateral segments.
双侧唇腭裂患者存在前颌骨突出以及特征性的颌骨畸形，包括前颌骨和双侧上颌骨段的三维错位。本研究对患有双侧唇腭裂且前颌骨及双侧上颌骨段存在偏斜和发育不全的患者进行了检查。在骨移植前，使用 Halo 型外部装置对每个骨段分别进行特殊牵张治疗。本报告描述了这种取得良好效果的新型治疗方法。
研究对象为 5 例因双侧唇腭裂导致严重颌骨畸形的患者。他们接受了上颌 Le Fort I 截骨术，随后使用 Halo 装置对每个骨段分别进行牵张。5 例患者中有 3 例未进行前颌骨截骨术，仅对发育严重不全的右侧和左侧外侧段进行了截骨和牵张。
所有患者均达到了接近预期的牵张量。牙槽裂宽度变窄，实现了满意的咬合关系和上颌弓形态。术后，5 例患者中有 3 例因双侧牙槽裂缺损接受了骨移植，骨移植存活情况良好。
该方法具有诸多益处，包括牙槽裂变窄、上颌发育不全得到改善以及实现良好的上颌弓形态。此外，后续对牙槽裂缺损进行骨移植有益，无需假牙，且手术次数和手术创伤性均有所减少。对于存在前颌骨突出以及右侧和左侧外侧段发育不全的双侧唇腭裂患者，该方法是一种应予以考虑的良好手术方式。
