Diaz-Siso J Rodrigo, Gibson Travis L, Plana Natalie M, Yue Olivia Y, Flores Roberto L
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY.
J Craniofac Surg. 2020 Jan/Feb;31(1):178-182. doi: 10.1097/SCS.0000000000005694.
The exophthalmos and class III malocclusion seen in Crouzon syndrome can be treated by Le Fort III advancement/distraction. However, reconstructive options for zygomatic retrusion are limited. The authors describe the repair of isolated exorbitism in a patient with Crouzon syndrome, via bilateral zygomatic rotation-advancement.
A 34-year-old woman with Crouzon syndrome complained of exorbitism and malar hypoplasia. Four years prior, she declined Le Fort III advancement and underwent orthodontic/orthognathic correction of malocclusion. Radiographs were used to develop a computerized surgical plan. Bilateral periorbital osteotomy with advancement/rotation of the zygomatic process was performed using custom osteotomy guides and plates. Images obtained immediately postoperative and 3- and 19-month postoperative were compared to assess surgical stability, accuracy, and soft tissue changes.
Decreased globe exposure and increased malar prominence have improved facial balance. Superimposed pre- and postoperative radiographs demonstrate bilateral advancement of the zygomatic body and inferior orbital rim. Superimposition of immediate postoperative and 19-month radiographs showed no relapse. Soft tissue histogram showed increased prominence of the malar eminence, lateral orbital rim, and cheek.
Zygomatic rotation-advancement proved a safe, effective, stable, and predictable treatment for isolated malar hypoplasia in a patient with Crouzon syndrome. Virtual planning can enhance novel complex craniofacial procedures.
克鲁宗综合征中出现的眼球突出和III类错牙合畸形可通过Le Fort III前移/牵引术进行治疗。然而，颧骨后缩的重建选择有限。作者描述了通过双侧颧骨旋转前移修复一名克鲁宗综合征患者的孤立性眼眶突出。
一名34岁的克鲁宗综合征女性患者主诉眼眶突出和颧骨发育不全。四年前，她拒绝了Le Fort III前移术，接受了错牙合畸形的正畸/正颌矫正。使用X线片制定计算机化手术计划。使用定制的截骨导向器和钢板进行双侧眶周截骨，并使颧骨进行前移/旋转。将术后即刻、术后3个月和19个月获得的图像进行比较，以评估手术的稳定性、准确性和软组织变化。
眼球暴露减少和颧骨突出增加改善了面部平衡。术前和术后X线片叠加显示双侧颧骨体和眶下缘前移。术后即刻和19个月X线片叠加显示无复发。软组织直方图显示颧骨隆起、眶外侧缘和脸颊更加突出。
颧骨旋转前移被证明是治疗克鲁宗综合征患者孤立性颧骨发育不全的一种安全、有效、稳定且可预测的方法。虚拟规划可以改进新颖复杂的颅面手术。
