Division of Oral and Maxillofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Plastic and Craniofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA.
Division of Plastic and Craniofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA.
Int J Oral Maxillofac Surg. 2020 Apr;49(4):466-470. doi: 10.1016/j.ijom.2019.08.006. Epub 2019 Sep 6.
The purpose was to assess maxillary position among patients undergoing Le Fort I maxillary advancement with internal fixation placed only at the nasomaxillary buttresses. This was a retrospective study of patients undergoing a Le Fort I osteotomy for maxillary advancement, with internal fixation placed only at the nasomaxillary buttresses. Demographic and cephalometric measures were recorded. The outcome of interest was the change in maxillary position between immediately postoperative (T1), 6 weeks postoperative (T2), and 1 year postoperative (T3). Fifty-eight patients were included as study subjects (32 male, 26 female; mean age 18.4±1.8 years). Twenty-five subjects (43.1%) had a diagnosis of cleft lip and palate. Forty-three subjects (74.1%) had bimaxillary surgery, 16 (27.6%) had bone grafts, and 18 (31.0%) had segmental maxillary osteotomies. At T3, there were no subjects with non-union, malunion, malocclusion, or relapse requiring repeat surgery. Mean linear changes between T1 and T3 were ≤1mm. Mean angular changes between T1 and T3 were <1°. There was no significant difference in stability in multi-segment maxillary osteotomies (P= 0.22) or with bone grafting (P= 0.31). In conclusion, anterior fixation alone in the Le Fort I osteotomy results in a stable maxillary position at 1 year postoperative.
目的在于评估仅在鼻上颌支柱处行内固定的 Le Fort I 上颌骨前徙术中上颌骨的位置。这是一项回顾性研究，纳入了仅在鼻上颌支柱处行内固定的 Le Fort I 截骨术治疗上颌骨前徙术的患者。记录了人口统计学和头影测量数据。主要观察结果是术后即刻（T1）、术后 6 周（T2）和术后 1 年（T3）上颌骨位置的变化。共有 58 例患者入选（32 例男性，26 例女性；平均年龄 18.4±1.8 岁）。25 例（43.1%）患者诊断为唇腭裂。43 例（74.1%）患者行双颌手术，16 例（27.6%）患者行骨移植，18 例（31.0%）患者行上颌骨节段性截骨术。在 T3 时，无未愈合、愈合不良、咬合不正或需要再次手术的复发患者。T1 至 T3 之间的平均线性变化值≤1mm。T1 至 T3 之间的平均角度变化值<1°。多节段上颌骨截骨术（P=0.22）或植骨术（P=0.31）的稳定性无显著差异。总之，Le Fort I 截骨术中仅行前方固定可使上颌骨在术后 1 年保持稳定的位置。
