Jackson I T
Insitute of Craniofacial, Plastic and Reconstructive Surgery, Providence Hospital, Southfield, Michigan.
Clin Plast Surg. 1989 Oct;16(4):757-75.
Maxillary hypoplasia and retrusion is complex. It may involve the dentoalveolar area, or it may involve the whole midface. It may be difficult to recognize, since the patient may come only with the complaint of nasal deformity, and the occlusion may be normal. It may be difficult to treat, as in the severe Binder's syndrome, where in addition to the bony deformity, the facial mask is deficient and obviously in the wrong position. To treat the condition the surgeon must have an aesthetic sense. It is not like the situation when only the maxilla is involved; this tends to be mechanical and is related to dental malocclusion. In these patients, an aesthetic appreciation of the nose and its relationship to the maxilla, infraorbital rims, and frontal area is paramount. Unless this complete approach is used, the patient will be undertreated and end up unhappy. Patients can readily appreciate the position and the contours of the nose, but they do not understand the subtleties of the lack of a bony foundation when there is maxillary hypoplasia. Not only does this involve a high degree of aesthetic appreciation on the part of the surgeon, it also necessitates a considerable ability to convey to the patients that the problem is not the simple one that they had first imagined. When all of these subtleties are appreciated, it is possible to develop a degree of sophistication in the treatment of these patients that will yield excellent results.
上颌骨发育不全和后缩情况复杂。它可能累及牙槽区域，也可能累及整个中面部。由于患者可能仅主诉鼻部畸形，而咬合可能正常，所以可能难以识别。治疗也可能困难，比如在严重的宾德综合征中，除了骨畸形外，面部覆盖物不足且位置明显不当。要治疗这种情况，外科医生必须具备审美意识。这与仅上颌骨受累的情况不同；那种情况往往比较机械，且与牙列咬合不正有关。在这些患者中，对鼻子及其与上颌骨、眶下缘和额部区域的关系进行审美评估至关重要。除非采用这种全面的方法，否则患者将得不到充分治疗，最终不满意。患者能够轻易察觉鼻子的位置和轮廓，但当上颌骨发育不全时，他们并不理解缺乏骨质基础的细微之处。这不仅需要外科医生具备高度的审美能力，还需要有相当的能力向患者传达问题并非他们最初想象的那么简单。当认识到所有这些细微之处时，就有可能在这些患者的治疗中发展出一定的成熟度，从而取得出色的效果。
