Shakir Sameer, Naran Sanjay, Lowe Kristen M, Bartlett Scott P
Division of Plastic and Reconstructive Surgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa.
Division of Plastic and Reconstructive Surgery, Advocate Children's Hospital, Park Ridge, Ill.
Plast Reconstr Surg Glob Open. 2018 Sep 14;6(9):e1856. doi: 10.1097/GOX.0000000000001856. eCollection 2018 Sep.
Vertical mandibular distraction results in translation of both proximal and distal segments. The force exerted on the condylar segment not only places unwanted force on the joint but also rotates the coronoid process into the cranial base. To prevent these sequelae, we investigate the use of a "check plate" on the condylar segment in an attempt to decrease force at the Temporomandibular joint (TMJ) and prevent unwanted rotation of the coronoid. Patients with hemifacial microsomia, seen at our Children's Hospital from 2012 to 2016 having undergone unilateral vertical mandibular distraction with placement of check plate were compared with a sample of those similarly having undergone distraction without use of the plate. Preoperative and postoperative cephalometric measures and 3-dimensional computed tomography imaging were analyzed. Three subjects were identified in each group. Age and Pruzansky-Kaban classification did not differ between groups. Vertical distance from the coronoid process perpendicular to the Frankfort Horizontal did not differ between groups ( < 0.07); however, postoperative distance significantly differed with the coronoid process rotating upward into the cranial base in subjects without a check plate ( < 0.005). Preoperative angle of the coronoid process based on the Frankfort Horizontal did not differ ( < 0.06); however, postoperative angle significantly changed, confirming upward rotation into the cranial base ( < 0.01). Total regenerate did not differ ( < 0.08). Vertical mandibular distraction results in undesirable upward rotation of the proximal segment into the cranial base and superior displacement of regenerate. This can be prevented with the use of a check plate.
垂直下颌骨牵张会导致近心段和远心段的移位。施加于髁突段的力不仅会给关节带来不必要的压力，还会使冠突向颅底旋转。为防止这些后遗症，我们研究在髁突段使用“阻挡板”，以试图减少颞下颌关节（TMJ）处的力，并防止冠突出现不必要的旋转。将2012年至2016年在我们儿童医院就诊、接受了单侧垂直下颌骨牵张并放置了阻挡板的半侧颜面短小畸形患者，与同样接受了牵张但未使用阻挡板的患者样本进行比较。分析术前和术后的头影测量数据以及三维计算机断层扫描成像。每组确定了3名受试者。两组之间的年龄和普鲁赞斯基 - 卡班分类没有差异。两组之间冠突垂直于法兰克福平面的垂直距离没有差异（<0.07）；然而，在未使用阻挡板的受试者中，术后该距离有显著差异，冠突向上旋转进入颅底（<0.005）。基于法兰克福平面的冠突术前角度没有差异（<0.06）；然而，术后角度有显著变化，证实冠突向上旋转进入颅底（<0.01）。总的骨再生情况没有差异（<0.08）。垂直下颌骨牵张会导致近心段出现不良的向上旋转进入颅底以及骨再生的向上移位。使用阻挡板可以防止这种情况发生。
