Complex Operating Unit of Maxillo-Facial Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, via Gramsci 14, 43100, Parma, Italy.
Oral Maxillofac Surg. 2021 Sep;25(3):401-410. doi: 10.1007/s10006-020-00916-w. Epub 2020 Oct 31.
Severe microretrognathia with the absence of ascending mandibular ramus is a challenging deformity and treatment must aim to avoid tracheostomy or remove it as soon as possible. Although it is not often reported, mandibular distraction osteogenesis represents a valid treatment option in infants affected by hypoplastic mandible Pruzansky-Kaban type IIb and III.
The authors describe 3 cases of infants affected by severe respiratory insufficiency due to congenital mandibular hypoplasia, with follow up ranging from 4 to 8 years. Clinical and technical considerations on treatment choices and outcomes are discussed starting from review of the literature and direct clinical experience.
Early mandibular distraction, specifically bidirectional distraction, is an effective and repeatable technique that leads to mandible lengthening with counterclockwise rotation, pogonion projection increase, anteropositioning of the tongue base, and expansion of oropharyngeal volume with positive effect on the respiratory problems of the infant. Even in Treacher Collins patients, known to have a low decannulation rate, all of these elements are essential for effective speech and swallowing therapy and for a subsequent attempt of decannulation.
严重的小下颌伴下颌升支缺如，是一种具有挑战性的畸形，治疗的目的必须是避免气管造口术或尽快去除它。虽然这种情况并不常见，但下颌骨牵引成骨术代表了一种有效的治疗方法，适用于下颌骨发育不全的婴儿，其 Pruzansky-Kaban 类型为 IIb 和 III 型。
作者描述了 3 例因先天性下颌骨发育不全而导致严重呼吸功能不全的婴儿病例，随访时间为 4 至 8 年。从文献回顾和直接临床经验出发，讨论了治疗选择和结果的临床和技术考虑因素。
早期的下颌骨牵引，特别是双向往复牵引，是一种有效且可重复的技术，可导致下颌骨延长、逆时针旋转、颏突前突增加、舌骨前位、口咽腔容积扩张，从而改善婴儿的呼吸问题。即使是在已知气管拔管率较低的特雷彻·柯林斯综合征患者中，所有这些因素对于有效的言语和吞咽治疗以及随后尝试拔管都是至关重要的。
