Tong Haizhou, Liu Lei, Tang Xiaojun, Song Tao, Yin Ningbei, Zhang Zhiyong, Zhao Zhenmin
*Department of Cleft Lip and Palate†Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Craniofac Surg. 2017 Sep;28(6):1573-1577. doi: 10.1097/SCS.0000000000003377.
Midface distraction osteogenesis has been popularized for the correction of midface hypoplasia associated with exophthalmos and obstructive sleep apnea in patients with Crouzon syndrome. The purpose of this study was to present the method of utilizing the modified external device with elastic distraction for the midface advancement in Crouzon syndrome, and the clinical outcomes and skeletal changes were analyzed.
Five consecutive patients with Crouzon syndrome underwent Le Fort III osteotomy with midface advancement using a modified external device with elastic distraction. The distraction system consists of a rigid external distractor, nickel-titanium shape memory alloy spring, and bone-borne traction hooks. The midface advancement was initiated with the bony anchorage around the nasomaxillary buttress at the level between occlusal plane and infraorbital margin. The device was activated at a rate of 1 to 1.5 mm per day by the length of spring. The skeletal changes were analyzed by cephalometric and computed tomographic measurement.
All the patients achieved improvements in midface appearance, obstructive sleep apnea, exophthalmos, and occlusion. No complications occurred during this procedure. After the distraction, 1 patient developed an open bite that was corrected by a definitive orthognathic surgery. Cephalometric and computed tomographic measurement analysis showed a differential advancement of midface with more at the occlusal level than the orbital level. In addition, midface suture and bone remodeling was also observed in growing patient.
Our modified external device with elastic distraction offers an alternative method to achieve midface advancement in patients with Crouzon syndrome.
面中部牵张成骨术已广泛应用于矫正克鲁宗综合征患者中与眼球突出和阻塞性睡眠呼吸暂停相关的面中部发育不全。本研究的目的是介绍利用改良外部弹性牵张装置进行克鲁宗综合征面中部前移的方法，并分析临床结果和骨骼变化。
连续5例克鲁宗综合征患者采用改良外部弹性牵张装置进行面中部前移的勒福Ⅲ型截骨术。牵张系统由刚性外部牵张器、镍钛形状记忆合金弹簧和骨承载牵引钩组成。面中部前移始于咬合平面与眶下缘之间水平的鼻上颌支柱周围的骨锚固。通过弹簧长度以每天1至1.5毫米的速度激活装置。通过头影测量和计算机断层扫描测量分析骨骼变化。
所有患者的面中部外观、阻塞性睡眠呼吸暂停、眼球突出和咬合均有改善。在此过程中未发生并发症。牵张后，1例患者出现开牙合，通过确定性正颌手术矫正。头影测量和计算机断层扫描测量分析显示面中部有差异前移，咬合水平比眶水平更明显。此外，在生长中的患者中还观察到面中部缝线和骨重塑。
我们改良的外部弹性牵张装置为克鲁宗综合征患者实现面中部前移提供了一种替代方法。
