The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands; Department of Plastic and Oral Surgery, (Head of department: Bonnie L. Padwa, DMD, MD), Boston Children's Hospital, Boston, United States.
The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands.
J Craniomaxillofac Surg. 2018 Sep;46(9):1427-1435. doi: 10.1016/j.jcms.2018.05.043. Epub 2018 May 25.
Mandibular reconstruction in craniofacial microsomia (CFM) has been described and reviewed at length although final results are not always (aesthetically) satisfactory due to maxillo-mandibular asymmetry, for which optimal correction techniques remain unclear. The aim of this systematic review is to provide an overview of the surgical options for maxillary correction in patients with unilateral CFM.
MEDLINE/Pubmed, Embase, Cochrane and Web of Science databases were searched up to April 15, 2017. Inclusion criteria were: studies reporting patients with unilateral CFM (n > 4) who had maxillary correction (with/without simultaneous mandibular correction) with a minimal follow-up of 6 months. The outcome measures included type of treatment (including preceding facial procedures), type and severity of mandibular deformity (by Pruzansky-Kaban system: Types I/IIa/IIb/III), asymmetry analysis method, outcome (i.e. occlusion, canting, stability, esthetic result, facial symmetry), complications and additional treatment needed.
Nine studies met the inclusion criteria. Analysis showed that Le Fort I + mandibular distraction osteogenesis (LeFort + MDO) and BiMaxillary osteotomy (BiMax) were used for treatment, as single or multiple-stage procedures. All studies reported aesthetic and functional improvement.
Types I/IIa benefited from LeFort + MDO; Type IIb from LeFort + MDO or BiMax; and Type III from BiMax (with 50% of cases having preceding mandibular procedures, including patient-fitted prosthesis) at a mean age of 20.2 years. Four studies recommended additional (esthetic) procedures.
颅面裂（CFM）患者的下颌骨重建已得到充分描述和回顾，尽管由于上下颌骨不对称，最终结果并不总是（在美学上）令人满意，因此最佳的矫正技术仍不明确。本系统评价的目的是对上颌骨矫正的手术选择进行综述，以评估单侧 CFM 患者的治疗效果。
检索 MEDLINE/Pubmed、Embase、Cochrane 和 Web of Science 数据库，检索时间截至 2017 年 4 月 15 日。纳入标准为：报道单侧 CFM 患者（n>4）的研究，患者接受上颌骨矫正（伴/不伴同期下颌骨矫正），且随访时间至少 6 个月。结局指标包括治疗类型（包括术前面部手术）、下颌骨畸形的类型和严重程度（按普赞斯基-卡班系统：I/IIa/IIb/III 型）、不对称分析方法、结局（即咬合、倾斜、稳定性、美观效果、面部对称性）、并发症和需要的额外治疗。
9 项研究符合纳入标准。分析表明，Le Fort I 联合下颌骨牵引成骨术（LeFort + MDO）和双颌骨截骨术（BiMax）用于治疗，包括单阶段或多阶段手术。所有研究均报道了美观和功能的改善。
I/IIa 型患者受益于 LeFort + MDO；IIb 型患者受益于 LeFort + MDO 或 BiMax；III 型患者受益于 BiMax（50%的患者有术前下颌骨手术，包括患者定制的假体），治疗平均年龄为 20.2 岁。4 项研究建议进行额外的（美容）手术。
