Liao Han-Tsung, Mittal Rashu, Kang Gavin, Chen Chien-Tzung
From the Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Linkou Chang Gung Memorial Hospital.
Ann Plast Surg. 2021 Feb 1;86(2S Suppl 1):S58-S63. doi: 10.1097/SAP.0000000000002651.
Le Fort fractures with maxillary immobility are an uncommon presentation of facial trauma often associated with the disturbance of occlusion. Historically, cases involving high Le Fort fractures require a coronal extensive approach to mobilize the maxilla for occlusion restoration. Here, we review our institutional series of immobile Le Fort fractures and present their treatment approach, outcomes, classification, and then rationalize our treatment with a concept philosophy.
We treated 12 consecutive patients with unilateral and bilateral immobile Le Fort fractures from 2010 to 2017. The mean age was 27.1 years. Ten patients had a unilateral greenstick Le Fort III fracture. Five patients also had associated mandible fractures. Intraoperative occlusions could only be restored after Le Fort I osteotomy was performed on the side of the immobile Le Fort fracture. The mean follow-up period was 1.6 years.
All patients presented good long-term occlusion restoration. There were no cases of nonunion or significant complications. None of the patients complained of any malar or periorbital cosmetic issues during follow-up sessions.
We presented an institutional series and classification of unusual Le Fort fractures with maxillary immobility, including a previously unreported fracture configuration of greenstick unilateral Le Fort III fractures combined with complete contralateral Le Fort I fracture. Based on our moment concept to rationalize treatment, as well as a systematic review of published literature, we advocate the judicious use of Le Fort I osteotomy to efficiently and safely treat these unusual fractures.
伴有上颌骨活动受限的Le Fort骨折是面部创伤的一种罕见表现，常伴有咬合紊乱。从历史上看，涉及高位Le Fort骨折的病例需要采用冠状面广泛入路来移动上颌骨以恢复咬合。在此，我们回顾了我们机构收治的一系列上颌骨活动受限的Le Fort骨折病例，并介绍了其治疗方法、结果、分类，然后用一种概念理念对我们的治疗方法进行了合理化分析。
2010年至2017年，我们连续治疗了12例单侧和双侧上颌骨活动受限的Le Fort骨折患者。平均年龄为27.1岁。10例患者为单侧青枝型Le Fort III骨折。5例患者还伴有下颌骨骨折。只有在活动受限的Le Fort骨折侧进行Le Fort I截骨术后，术中咬合才能恢复。平均随访期为1.6年。
所有患者均获得了良好的长期咬合恢复。没有骨不连或严重并发症的病例。在随访期间，没有患者抱怨任何颧骨或眶周的美容问题。
我们展示了一组机构内收治的伴有上颌骨活动受限的不寻常Le Fort骨折病例及其分类，包括一种以前未报道过的青枝型单侧Le Fort III骨折合并对侧完全性Le Fort I骨折的骨折类型。基于我们用于合理化治疗的力矩概念以及对已发表文献的系统回顾，我们主张明智地使用Le Fort I截骨术来有效且安全地治疗这些不寻常的骨折。
