Gibson Travis L, Grayson Barry H, McCarthy Joseph G, Shetye Pradip R
Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York.
J Craniofac Surg. 2018 Sep;29(6):1535-1541. doi: 10.1097/SCS.0000000000004608.
Le Fort III distraction osteogenesis may be indicated in the treatment of syndromic craniosynostosis with severe midface retrusion and proptosis. This study assesses the stability of proptosis correction over 10-years.A retrospective review identified 15 patients with syndromic craniosynostosis treated by Le Fort III distraction prior to age 10 (9 males, 6 females; age 4.9 ± 1.5 years). Untreated, non-craniosynostotic age- and gender-matched controls were obtained from historical growth records. Lateral cephalometric tracings at pre-surgery (T1), immediate (T2), 1 year (T3), 5 years (T4), and 10 years (T5) (n = 11) post-distraction were superimposed using the best-fit of cranial base. Proptosis severity was defined as the horizontal distance between the Ant. Globe cephalometric point and orbital rim landmarks Orbitale and Lat. Orbit.The orbital rim advanced 10.54 ± 3.78 mm (P < 0.001) at Orbitale and 9.73 ± 4.54 mm (P > 0.001) at Lat. Orbit from T1 to T2; Ant. Globe advanced 3.13 ± 3.02 mm (p 0.001). Proptosis decreased 7.41 ± 5.29 mm (P < .001) from Orbitale and 6.60 ± 6.50 mm (p 0.002) from Lat. Orbit. Comparison to controls demonstrated phenotypic correction. In craniosynostotic patients from T2 to T5, the bony orbital rim demonstrated non-significant remodeling posteriorly and inferiorly. Anterior Globe moved 3.79 ± 1.47 mm anteriorly (P < .001), which did not differ significantly from controls. Proptosis increased by 4.18 ± 2.94 mm in craniosynostotic patients from T2 to T5.Le Fort III distraction was stable, with no significant anteroposterior relapse of the maxilla or bony orbit. Phenotypic relapse of proptosis to pre-treatment levels occurred through deficient growth of the midface, surface resorption at the orbital rim, and preservation of normal forward movement of Ant. Globe.
勒福Ⅲ型牵引成骨术可用于治疗伴有严重面中部后缩和眼球突出的综合征性颅缝早闭。本研究评估了10年间眼球突出矫正的稳定性。一项回顾性研究确定了15例10岁前接受勒福Ⅲ型牵引治疗的综合征性颅缝早闭患者（9例男性，6例女性；年龄4.9±1.5岁）。从未经治疗、非颅缝早闭且年龄和性别匹配的历史生长记录中获取对照。使用颅底最佳拟合将牵引术前（T1）、即刻（T2）、1年（T3）、5年（T4）和10年（T5）（n = 11）时的头颅侧位X线描记图进行叠加。眼球突出严重程度定义为头颅侧位片中前颅底点与眶缘标志点眶点和外侧眶点之间的水平距离。从T1到T2，眶点处眶缘前移10.54±3.78 mm（P < 0.001），外侧眶点处前移9.73±4.54 mm（P > 0.001）；前颅底点前移3.13±3.02 mm（P < 0.001）。眼球突出从眶点处减少7.41±5.29 mm（P < 0.001），从外侧眶点处减少6.60±6.50 mm（P < 0.002）。与对照相比显示出表型矫正。在颅缝早闭患者中，从T2到T5，骨性眶缘向后和向下的重塑不显著。前颅底点向前移动3.79±1.47 mm（P < 0.001），与对照无显著差异。颅缝早闭患者从T2到T5眼球突出增加4.18±2.94 mm。勒福Ⅲ型牵引是稳定的，上颌骨或骨性眼眶没有明显的前后复发。眼球突出表型复发至治疗前水平是由于面中部生长不足、眶缘表面吸收以及前颅底点正常向前移动的保留。
