Wang Zong-qi, Wang Xiao-xia, Li Zi-li, Yi Biao, Liang Cheng, Wang Xin
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2015 Feb 18;47(1):104-8.
To identify nasal width changes occurring after Le Fort I osteotomy and to compare prospectively the effect of three surgical techniques for controlling postoperative nasal width.
In the study, 79 patients (22 male and 57 female, mean age 23.2 ± 3.4 years), who received Le Fort I osteotomy at Peking University Hospital of Stomatology from 2011 to 2014, were randomly divided into three groups. Group 1 was treated with traditional intraoral alar base cinch suture (ABCS); Group 2 with extraoral ABCS, and Group 3 with traditional ABCS plus an extra intraoral suture at points G.lat. All the patients had taken 3D photos using 3dMD camera before operation, and 3, and 6 months after operation. The nasal widths, which were indicated as distances between Sbal-Sbal, G.lat-G.lat and Al-Al, were measured by two examiners in the 3D photos three times with a time-interval of one week. SPSS 13.0 was used to do the statistic analysis.
At the end of the postoperative 6 months, the nasal widths lessened as compared with the postoperative 3 months. No significant differences were found between the three groups 6 months after the operation. The degree of the postoperative nasal width widening had positive correlation with that of the intraoperative nasal width widening, and had negative correlation with the initial nasal width and the amount of post-suture narrowing.
There is no difference between three suturing techniques for controlling nasal width widening after Le Fort I osteotomy. The postoperative nasal width-widening can't be totally avoided, and the alteration might last at least 6 months after the operation. For patients with narrow nasal width and need to move maxilla forward, more overcorrection of ABCS is needed to control the postoperative nasal base widening.
确定Le Fort I型截骨术后鼻宽度的变化,并前瞻性比较三种手术技术控制术后鼻宽度的效果。
本研究纳入了2011年至2014年在北京大学口腔医院接受Le Fort I型截骨术的79例患者(男22例,女57例,平均年龄23.2±3.4岁),将其随机分为三组。第1组采用传统口内鼻翼基底收紧缝合术(ABCS);第2组采用口外ABCS,第3组采用传统ABCS加在G.lat点额外进行口内缝合。所有患者在术前、术后3个月和6个月使用3dMD相机拍摄三维照片。由两名检查者在三维照片上对鼻宽度(以Sbal-Sbal、G.lat-G.lat和Al-Al之间的距离表示)进行三次测量,每次测量间隔一周。使用SPSS 13.0进行统计分析。
术后6个月末,鼻宽度较术后3个月减小。术后6个月三组之间未发现显著差异。术后鼻宽度增宽程度与术中鼻宽度增宽程度呈正相关,与初始鼻宽度和缝合后缩小量呈负相关。
三种缝合技术在控制Le Fort I型截骨术后鼻宽度增宽方面无差异。术后鼻宽度增宽无法完全避免,且这种改变可能在术后至少持续6个月。对于鼻宽度窄且需要上颌前徙的患者,需要更多地过度矫正ABCS以控制术后鼻基底增宽。