Sharma Ashish P, Stringer Dale E
Assistant Professor, Department of Oral and Maxillofacial Surgery, Loma Linda University School of Dentistry, Loma Linda, CA.
Professor, Department of Oral and Maxillofacial Surgery, Loma Linda University School of Dentistry, Loma Linda, CA; Private Practice, Riverside, CA.
J Oral Maxillofac Surg. 2019 May;77(5):1068.e1-1068.e36. doi: 10.1016/j.joms.2019.01.039. Epub 2019 Feb 5.
Correction of maxillofacial skeletal dental deformities often includes surgical interventions in the maxilla and mandible. Le Fort I maxillary osteotomies are performed to correct maxillary horizontal, vertical, and transverse discrepancies. Repositioning of the maxilla creates an interpositional gap in bone that can lead to pseudoarthrosis, instability, mobility, infection, and eventual relapse. Grafting the interpositional gap with bone creates mechanical stops to prevent relapse, provides a matrix for secondary ossification, accelerates bony union, and inhibits soft tissue herniation. This can be accomplished using autogenous bone harvested from the patient. Donor sites include the calvarium, rib, and iliac crest bone. Although these donor sites have their advantages and specific indications, they require a second surgical site, which can lead to potential complications, such as infection, donor site morbidity, pneumothorax, and gait disturbances. In conjunction with the Le Fort I maxillary osteotomy, for correction of maxillary deformities, the bilateral sagittal split mandibular osteotomy is a common procedure used for mandibular advancement, setback, and correction of mandibular asymmetry with or without concurrent genioplasty. Five patients (1 man and 4 women) underwent orthognathic surgery for correction of their maxillofacial skeletal dental deformities at the Loma Linda University Hospitals (Loma Linda, CA) from 2015 through 2017. This case series describes a technique to harvest autogenous bone from the posterior aspect of the distal sagittal split osteotomy segment of the mandible, which is milled and used to graft the interpositional gap in the maxilla. Principles of guided bone regeneration are incorporated to improve surgical outcomes.
颌面部骨骼牙齿畸形的矫正通常包括对上颌骨和下颌骨的手术干预。进行勒福Ⅰ型上颌骨截骨术以矫正上颌骨的水平、垂直和横向差异。上颌骨的重新定位会在骨中产生一个间隙，这可能导致假关节形成、不稳定、活动度增加、感染以及最终的复发。用骨移植该间隙可形成机械阻挡以防止复发，提供二次骨化的基质，加速骨愈合，并抑制软组织疝出。这可以使用从患者身上获取的自体骨来完成。供骨部位包括颅骨、肋骨和髂嵴骨。尽管这些供骨部位有其优点和特定适应症，但它们需要第二个手术部位，这可能导致潜在的并发症，如感染、供骨部位并发症、气胸和步态障碍。结合勒福Ⅰ型上颌骨截骨术，为矫正上颌骨畸形，双侧矢状劈开下颌骨截骨术是一种常用的手术，用于下颌骨前移、后退以及矫正下颌骨不对称，可伴有或不伴有同期颏成形术。2015年至2017年期间，5名患者（1名男性和4名女性）在洛马林达大学医院（加利福尼亚州洛马林达）接受了正颌手术以矫正其颌面部骨骼牙齿畸形。本病例系列描述了一种从下颌骨远端矢状劈开截骨段后侧获取自体骨的技术，该骨经研磨后用于移植上颌骨的间隙。引入引导性骨再生原则以改善手术效果。
