Safi Ali-Farid, Kreppel Matthias, Kauke Martin, Grandoch Andrea, Nickenig Hans-Joachim, Zöller Joachim
Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany.
J Craniofac Surg. 2018 Jan;29(1):170-174. doi: 10.1097/SCS.0000000000004061.
Due to the complex development of the craniofacial skull, corrective surgery is a major challenge for patients with severe craniofaciostenosis. Although fronto-orbital advancement and simultaneous LeFort-III osteotomy in combination with distraction osteogenesis have been reported as a safe and successful method to obtain good esthetic and functional results, there is a lack of studies evaluating this method.Our retrospective study included 12 patients with syndromic craniofaciostenosis, who were primarily treated at our department in accordance with a standardized treatment protocol, consisting of a simultaneous fronto-orbital advancement with LeFort-III osteotomy in combination with a rigid external distractor (RED-II). Distraction distance, duration of operation, postoperative complications, perioperative hemoglobin concentration, esthetic outcome, and the subjective Whitaker Scale were used to evaluate the success of our surgical method.The esthetic outcome of all of our patients was assessed as good. Furthermore, the surgical outcome was assigned I for 11 patients and II for 1 patient, who suffered from wound healing disturbance at the left temporal site, which required revision 2 weeks postoperatively. The mean skeletal advancement of the midface was 16.4 mm, ranging from 12 to 20 mm.Our standardized treatment protocol, consisting of fronto-orbital advancement in combination with LeFort-III osteotomy and application of a rigid external distractor device (RED-III) for patients with severe syndromic craniofaciostenosis, goes along with low infection rates and more predictable and precise esthetic and functional outcomes than the conventional surgical technique without distraction osteogenesis.
由于颅面颅骨的发育复杂，矫正手术对于重度颅面狭窄症患者来说是一项重大挑战。尽管额眶前移术以及同期勒福III型截骨术联合牵引成骨术已被报道是一种安全且成功的方法，能取得良好的美学和功能效果，但缺乏对该方法的研究。我们的回顾性研究纳入了12例综合征性颅面狭窄症患者，他们主要在我们科室按照标准化治疗方案接受治疗，该方案包括同期额眶前移术与勒福III型截骨术，并结合使用坚固外固定牵引器（RED-II）。采用牵引距离、手术时长、术后并发症、围手术期血红蛋白浓度、美学效果以及主观惠特克量表来评估我们手术方法的成功率。我们所有患者的美学效果评估为良好。此外，11例患者的手术结果评定为I级，1例患者因左侧颞部伤口愈合障碍评定为II级，该患者术后2周需要进行修复。面中部的平均骨骼前移量为16.4毫米，范围在12至20毫米之间。我们的标准化治疗方案，即对于重度综合征性颅面狭窄症患者采用额眶前移术联合勒福III型截骨术并应用坚固外固定牵引器装置（RED-III），与传统无牵引成骨术的手术技术相比，具有较低的感染率以及更可预测、更精确的美学和功能效果。
