Chang Catherine S, Swanson Jordan, Yu Jason, Taylor Jesse A
*Division of Plastic and Reconstructive Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania †Division of Plastic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.
J Craniofac Surg. 2017 Jun;28(4):931-934. doi: 10.1097/SCS.0000000000003567.
Traditionally, maxillary hypoplasia in the setting of cleft lip and palate is treated via orthognathic surgery at skeletal maturity, which condemns these patients to abnormal facial proportions during adolescence. The authors sought to determine the safety profile of computer-aided design/computer-aided modeling (CAD/CAM) planned, Le Fort I distraction osteogenesis with internal distractors in select patients presenting at a young age with severe maxillary retrusion. The authors retrospectively reviewed our "early" Le Fort I distraction osteogenesis experience-patients performed for severe maxillary retrusion (≥12 mm underjet), after canine eruption but prior to skeletal maturity-at a single institution. Patient demographics, cleft characteristics, CAD/CAM operative plans, surgical complications, postoperative imaging, and outcomes were analyzed. Four patients were reviewed, with a median age of 12.8 years at surgery (range 8.6-16.1 years). Overall mean advancement was 17.95 + 2.9 mm (range 13.7-19.9 mm) with mean SNA improved 18.4° to 87.4 ± 5.7°. Similarly, ANB improved 17.7° to a postoperative mean of 2.4 ± 3.1°. Mean follow-up was 100.7 weeks, with 3 of 4 patients in a Class I occlusion with moderate-term follow-up; 1 of 4 will need an additional maxillary advancement due to pseudo-relapse. In conclusion, Le Fort I distraction osteogenesis with internal distractors is a safe procedure to treat severe maxillary hypoplasia after canine eruption but before skeletal maturity. Short-term follow-up demonstrates safety of the procedure and relative stability of the advancement. Pseudo-relapse is a risk of the procedure that must be discussed at length with patients and families.
传统上，唇腭裂患者的上颌骨发育不全是在骨骼成熟时通过正颌手术进行治疗的，这使得这些患者在青春期面部比例异常。作者试图确定在一些年龄较小、上颌严重后缩的患者中，采用计算机辅助设计/计算机辅助建模（CAD/CAM）规划、使用内部牵引器的Le Fort I型牵引成骨术的安全性。作者回顾性分析了我们在一家机构进行的“早期”Le Fort I型牵引成骨术的经验，这些患者因严重上颌后缩（下颌前突≥12毫米）接受手术，手术时间在尖牙萌出后但骨骼成熟前。分析了患者的人口统计学特征、腭裂特点、CAD/CAM手术方案、手术并发症、术后影像学检查和治疗结果。共对4例患者进行了评估，手术时的中位年龄为12.8岁（范围8.6 - 16.1岁）。总体平均前移量为17.95 + 2.9毫米（范围13.7 - 19.9毫米），平均SNA角从18.4°改善至87.4 ± 5.7°。同样，ANB角从17.7°改善至术后平均2.4 ± 3.1°。平均随访100.7周，4例患者中有3例在中期随访时达到I类咬合；4例中有1例因假性复发需要再次进行上颌前移。总之，使用内部牵引器的Le Fort I型牵引成骨术是一种治疗尖牙萌出后但骨骼成熟前严重上颌骨发育不全的安全手术方法。短期随访显示了该手术的安全性和前移后的相对稳定性。假性复发是该手术的一个风险，必须与患者及其家属详细讨论。
