Tobolowsky William, Gupta Pranjal, Lopez Joseph, Cho Regina, Mundinger Gerhard S, Yang Robin, Tufaro Anthony P
Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD.
Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, and Director of Plastic Surgery, Children's Hospital of New Orleans, New Orleans, LA.
J Craniofac Surg. 2019 Oct;30(7):1974-1978. doi: 10.1097/SCS.0000000000005620.
Maxillary hypoplasia after cleft lip and palate (CLP) repair can result in significant functional and aesthetic impairments. Le Fort I osteotomy & advancement and Le Fort I distraction osteogenesis are standard treatment options for individuals with CLP-associated midface retrusion. However, both of these modalities continue to be associated with a high relapse rate. This study describes surgical outcomes of a 2-stage technique utilizing distraction osteogenesis combined with bone grafting and rigid fixation, which may optimize skeletal stability by reducing relapse.
A retrospective review of CLP patients with severe maxillary hypoplasia evaluated by a single surgeon from 2003 to 2014 was performed. Twenty-one subjects were identified that underwent maxillary advancement via a 2-stage technique: (1) Le Fort I external rigid distraction using a HALO device, followed by (2) autologous iliac crest bone graft application and plate-fixation. Post-operative cephalograms were taken on average 1-year following surgery.
Twelve subjects met the inclusion/exclusion criteria. A distraction rate of 1 mm/day was achieved with an average of 14 mm of maxillary advancement. Average increase in SNA was +9.03°, with an increase from 71.84° to 80.88° (normal = 82.0°, P value <0.0001), with no significant change in SNB, and a +9.63° change in ANB from -7.76° to 1.88° (normal = 1.6°, P value <0.0001).
The described 2-step procedure had similar cephalometric improvements as compared to distraction osteogenesis alone. However, successive bone grafting and rigid fixation as a second procedure may help ameliorate relapse risk and optimize the correction of maxillary hypoplasia in susceptible populations.
唇腭裂（CLP）修复术后上颌骨发育不全可导致严重的功能和美学障碍。Le Fort I截骨术及前移术和Le Fort I牵引成骨术是治疗CLP相关面中部后缩患者的标准治疗选择。然而，这两种治疗方式的复发率仍然很高。本研究描述了一种两阶段技术的手术效果，该技术采用牵引成骨术结合骨移植和坚固内固定，通过减少复发来优化骨骼稳定性。
对2003年至2014年由单一外科医生评估的严重上颌骨发育不全的CLP患者进行回顾性研究。确定了21名接受两阶段上颌骨前移手术的受试者：（1）使用HALO装置进行Le Fort I外固定牵引，然后（2）进行自体髂嵴骨移植和钢板固定。术后平均1年拍摄头颅侧位片。
12名受试者符合纳入/排除标准。牵引速率为1毫米/天，平均上颌骨前移14毫米。SNA平均增加+9.03°，从71.84°增加到80.88°（正常=82.0°，P值<0.0001），SNB无显著变化，ANB从-7.76°变化到+9.63°（正常=1.6°，P值<0.0001）。
与单纯牵引成骨术相比，所述的两步手术在头影测量改善方面相似。然而，作为第二步手术的连续骨移植和坚固内固定可能有助于降低复发风险，并优化易感人群上颌骨发育不全的矫正效果。
