Gwanmesia Ivo, Jeelani Owase, Hayward Richard, Dunaway David
London, United Kingdom From the Great Ormond Street Hospital for Children.
Plast Reconstr Surg. 2015 Feb;135(2):553-560. doi: 10.1097/PRS.0000000000001115.
Frontofacial advancement by distraction osteogenesis is known to produce significant functional and aesthetic gains in the short and medium term. Little is known about the long-term effects of this technique. The authors present a long-term review of frontofacial advancement by distraction in patients with syndromic craniosynostosis.
In 2008, Witherow et al. presented functional outcomes in 20 consecutive patients who underwent frontofacial advancement by distraction osteogenesis using the rigid external distractor frame. This retrospective study has revisited the outcomes in these patients after a mean follow-up period of 10.2 years.
Records for the original 20 patients were assessed. Cephalometric analysis demonstrated stable advancements over the long term. No patient achieved any anterior growth of the midface after frontofacial advancement. Long-term follow-up demonstrated a later deterioration of respiratory function in the younger group of patients (36.4 percent). Four patients required adenotonsillectomy. One patient has a persistent tracheostomy. Only one patient required further procedures to correct recurrent raised intracranial pressure. None of the patients in the older group experienced a deterioration of function. Other procedures included reduction of the supraorbital ridge, bimaxillary osteotomies, and rhinoplasties.
Frontofacial distraction produced long-term stable advancement in all cases, and 15 of the 17 living patients (88.2 percent) achieved stable functional gains. Anterior growth of the midface does not occur following monobloc distraction. Deterioration in function is seen in those who undergo this procedure at a young age. The authors recommend regular follow-up of these patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
已知通过牵张成骨进行额面部前移在短期和中期能带来显著的功能和美学改善。关于该技术的长期影响知之甚少。作者对综合征性颅缝早闭患者通过牵张进行额面部前移进行了长期回顾。
2008年，威瑟罗等人报告了20例连续接受使用刚性外部牵张器框架进行牵张成骨额面部前移患者的功能结果。这项回顾性研究在平均随访10.2年后重新评估了这些患者的结果。
对最初20例患者的记录进行了评估。头影测量分析显示长期前移稳定。额面部前移后，没有患者实现面中部的任何向前生长。长期随访显示，较年轻患者组（36.4%）的呼吸功能在后期恶化。4例患者需要行腺样体扁桃体切除术。1例患者持续进行气管造口术。只有1例患者需要进一步手术来纠正复发性颅内压升高。老年组患者均未出现功能恶化。其他手术包括眶上嵴降低术、双颌截骨术和鼻整形术。
额面部牵张在所有病例中均产生了长期稳定的前移，17例在世患者中有15例（88.2%）实现了稳定的功能改善。整块牵张后面中部不会向前生长。在年轻时接受该手术的患者中可见功能恶化。作者建议对这些患者进行定期随访。
临床问题/证据水平：治疗性，IV级。
