Craniofacial Department, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil.
Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI.
J Craniofac Surg. 2021;32(1):87-91. doi: 10.1097/SCS.0000000000006997.
Facial advancement represents the essence of the surgical treatment of syndromic craniosynostosis. Frontofacial monobloc distraction is an effective surgical approach to correct midface retrusion although someone consider it very hazardous procedure. The authors evaluated a group of patients who underwent frontofacial monobloc distraction with the aim to identify the advancement results performed in immature skeletal regarding the midface morphologic characteristics and its effects on growth.
Sixteen patients who underwent frontofacial monobloc distraction with pre- and postsurgical computed tomography (CT) scans were evaluated and compared to a control group of 9 nonsyndromic children with CT scans at 1-year intervals during craniofacial growth. Three-dimensional measurements and superimposition of the CT scans were used to evaluate midface morphologic features and longitudinal changes during the craniofacial growth and following the advancement. Presurgical growth was evaluated in 4 patients and postsurgical growth was evaluated in 9 patients.
Syndromic maxillary width and length were reduced and the most obtuse facial angles showed a lack in forward projection of the central portion in these patients. Three-dimensional distances and images superimposition demonstrated the age did not influence the course of abnormal midface growth.
The syndromic midface is hypoplastic and the sagittal deficiency is associated to axial facial concavity. The advancement performed in mixed dentition stages allowed the normalization of facial position comparable to nonsyndromic group. However, the procedure was not able to change the abnormal midface architecture and craniofacial growth.
面部前徙是综合征性颅缝早闭治疗的核心。颅面整块牵张成骨术是一种有效的中面部后缩矫正方法，尽管有人认为这是一种非常危险的手术。作者评估了一组接受颅面整块牵张成骨术的患者，目的是确定在不成熟的骨骼中进行中面部形态特征的前徙结果，及其对生长的影响。
对 16 例接受颅面整块牵张成骨术的患者进行了术前和术后计算机断层扫描（CT）检查，并与 9 例非综合征性儿童的 CT 检查进行了比较，这些儿童在颅面生长过程中每 1 年进行一次 CT 检查。使用三维测量和 CT 扫描叠加来评估中面部形态特征以及颅面生长过程中和前徙后的纵向变化。对 4 例患者进行了术前生长评估，对 9 例患者进行了术后生长评估。
综合征性上颌宽度和长度减小，最钝角的面角显示中央部分向前投影不足。三维距离和图像叠加表明，年龄并不影响异常中面部生长的过程。
综合征性中面部发育不良，矢状面不足与面轴部凹陷有关。在混合牙列期进行的前徙术可以使面部位置正常化，与非综合征组相当。然而，该手术并不能改变异常的中面部结构和颅面生长。
