Bawane Shilpa S, Andrade Neelam N
Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College and Hospital Pimpri, Pune, India.
Department of Oral and Maxillofacial Surgery, Nair Hospital and Dental College Mumbai, Dr A. L. Nair Road, Mumbai Central, Mumbai, 400008 India.
J Maxillofac Oral Surg. 2016 Dec;15(4):491-500. doi: 10.1007/s12663-016-0883-9. Epub 2016 Mar 16.
(1) To highlight the role of intraoral submerged device in distraction osteogenesis (DO) of patients requiring two jaw surgeries for the correction of severe developmental maxillary hypoplasia (MH) and mandibular prognathism (MP) (2) To analyse the hard and soft tissue changes following maxillary DO and mandibular setback with bilateral sagittal split osteotomy (BSSO) in patients with severe MH and MP requiring two jaw surgeries.
During the period Jan 2004 to Dec 2006, five patients with severe developmental MH along with MP were treated. In 1st stage maxillary distraction was done. Distraction started on 6th postoperative day, 1 mm distraction was carried out for 10-15 days on either side. Serial radiographs were taken immediate postoperative period for baseline comparison, post-distraction and at the end of distraction. After a period of 3-4 months of distraction 2nd stage was done. In 2nd stage, mandibular setback was done with BSSO and distractors were removed under general anesthesia. Radiographs were taken immediately and at 4 months post-operatively. Cephalometric tracings were carried out preoperatively, post DO and finally after mandibular setback with BSSO.
The mean horizontal movement of maxilla was 11.4 mm at ANS and 9.6 mm at A point. Upper incisor edge was advanced by 8.8 mms. SNA increased by 8.4° and SNB decreased by 4.6°. Nasal projection advanced by 4°. Nasolabial angle normalized in all patients, mean change achieved was 10.8°. Upper lip moved forward by 5.4 mm. Lower lip moved backward by 5.4 mm. Mandible positioned backward by 4 mm at B point. No vertical change occurred in the position of A, ANS and upper incisor edges. Mean increase in skeletal angle of convexity was 26.4°. Concave profile was significantly changed to convex in all patients.
Maxillary DO and mandibular setback with BSSO was associated with improved facial balance and esthetics.
（1）强调口内植入式装置在需要进行双颌手术以矫正严重发育性上颌骨发育不全（MH）和下颌前突（MP）患者的牵张成骨（DO）中的作用。（2）分析在需要双颌手术的严重MH和MP患者中，上颌DO和下颌双侧矢状劈开截骨术（BSSO）后退术后硬组织和软组织的变化。
在2004年1月至2006年12月期间，对5例患有严重发育性MH伴MP的患者进行了治疗。第一阶段进行上颌牵张。牵张在术后第6天开始，两侧每天牵张1mm，持续10 - 15天。术后即刻拍摄系列X线片作为基线对照，牵张后及牵张结束时也进行拍摄。牵张3 - 4个月后进行第二阶段手术。在第二阶段，在全身麻醉下通过BSSO进行下颌后退并取出牵张器。术后即刻及术后4个月拍摄X线片。术前、DO术后以及最终下颌BSSO后退术后进行头影测量描记。
上颌在ANS点的平均水平移动为11.4mm，在A点为9.6mm。上前牙切缘前移8.8mm。SNA增加8.4°，SNB减少4.6°。鼻突前移4°。所有患者鼻唇角恢复正常，平均变化为10.8°。上唇向前移动5.4mm。下唇向后移动5.4mm。下颌在B点向后移动4mm。A点、ANS点和上前牙切缘的位置没有垂直变化。骨骼凸度角平均增加26.4°。所有患者的凹面型显著转变为凸面型。
上颌DO和下颌BSSO后退术可改善面部平衡和美观。
