Park Young-Wook, Kwon Kwang-Jun, Kim Min-Keun
Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung, 210-702 South Korea.
Maxillofac Plast Reconstr Surg. 2016 May 3;38(1):20. doi: 10.1186/s40902-016-0069-x. eCollection 2016 Dec.
Most of cleft lip and palate patients have the esthetic and functional problems of midfacial deficiencies due to innate developmental tendency and scar tissues from repeated operations. In these cases, maxillary protraction is required for the harmonious facial esthetics and functional occlusion.
A 7-year old boy had been diagnosed as severe maxillary constriction due to unilateral complete cleft lip and palate. The author tried to correct the secondary deformity by early distraction osteogenesis with the aim of avoiding marked psychological impact from peers of elementary school. From 1999 to 2006, repeated treatments, which consisted of Le Fort I osteotomy and face mask distraction, and complementary maxillary protraction using miniplates were performed including orthodontics. But, final facial profile was not satisfactory, which needs compromising surgery.
The result of this study suggests that if early distraction treatment is performed before facial skeletal growth is completed, an orthognathic surgery or additional distraction may be needed later. Maxillofacial plastic and reconstructive surgeons should notify this point when they plan early distraction treatment for cleft maxillary deformity.
大多数唇腭裂患者由于先天发育趋势以及多次手术留下的瘢痕组织，存在面中部发育不足的美学和功能问题。在这些病例中，为了实现面部美学和谐与功能咬合，需要进行上颌骨前牵引。
一名7岁男孩因单侧完全性唇腭裂被诊断为严重上颌骨狭窄。作者试图通过早期牵张成骨来纠正继发畸形，目的是避免来自小学同学的明显心理影响。从1999年到2006年，进行了包括正畸治疗在内的多次治疗，这些治疗包括Le Fort I截骨术和面罩牵引，以及使用微型钢板进行辅助上颌骨前牵引。但是，最终的面部轮廓并不令人满意，需要进行折衷手术。
本研究结果表明，如果在面部骨骼生长完成之前进行早期牵引治疗，后期可能需要进行正颌手术或额外的牵引。颌面整形和重建外科医生在为腭裂上颌畸形计划早期牵引治疗时应注意这一点。
