Fahradyan Artur, Wolfswinkel Erik M, Clarke Noreen, Park Stephen, Tsuha Michaela, Urata Mark M, Hammoudeh Jeffrey A, Yamashita Dennis-Duke R
1 Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
2 Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.
Cleft Palate Craniofac J. 2018 Apr;55(4):546-553. doi: 10.1177/1055665617739731. Epub 2018 Jan 4.
The maxillary horizontal relapse following Le Fort I advancement has been estimated to be 10% to 50%. This retrospective review examines the direct association between the amounts of maxillary advancement and relapse. We hypothesize that the greater the advancement, the greater the relapse amount.
Patients with class III skeletal malocclusion underwent maxillary advancement with either a Le Fort I or a Le Fort I with simultaneous mandibular setback (bimaxillary surgery) from 2008 to 2015. Patients were assessed for a history of cleft lip or cleft palate. Patients with known syndromes were excluded. Cephalometric analysis was performed to compare surgical and postsurgical changes.
Of 136 patients, 47.1% were males and 61.8% had a history of cleft. The mean surgery age was 18.9 (13.8-23) years and 53.7% underwent a bimaxillary procedure. A representative subgroup of 35 patients had preoperative, immediate postoperative, and an average of 1-year postoperative lateral cephalograms taken. The mean maxillary advancement was 6.3 mm and the horizontal relapse was 1.8 mm, indicating a 28.6% relapse. A history of cleft and amount of maxillary advancement were directly correlated, whereas bone grafting of the maxillary osteotomy sites was inversely correlated with the amount of relapse ( P < .05).
Our data suggest positive correlation between amount of maxillary advancement and horizontal relapse as well as a positive correlation between history of cleft and horizontal relapse. Bone grafting of the maxillary osteotomy sites has a protective effect on the relapse.
据估计，Le Fort I型上颌前徙术后上颌水平复发率为10%至50%。本回顾性研究探讨上颌前徙量与复发之间的直接关联。我们假设前徙量越大，复发量越大。
2008年至2015年期间，对III类骨性错牙合患者进行Le Fort I型上颌前徙术或Le Fort I型上颌前徙术联合下颌后退术（双颌手术）。评估患者唇腭裂病史。排除已知综合征患者。进行头影测量分析以比较手术前后的变化。
136例患者中，47.1%为男性，61.8%有唇腭裂病史。平均手术年龄为18.9（13.8 - 23）岁，53.7%接受双颌手术。选取35例患者组成代表性亚组，拍摄术前、术后即刻及术后平均1年的头颅侧位片。上颌平均前徙量为6.3 mm，水平复发量为1.8 mm，复发率为28.6%。唇腭裂病史与上颌前徙量呈正相关，而上颌截骨部位植骨与复发量呈负相关（P < .05）。
我们的数据表明上颌前徙量与水平复发之间呈正相关，唇腭裂病史与水平复发之间也呈正相关。上颌截骨部位植骨对复发有保护作用。
