Department of Orthodontics, Mahidol University, Bangkok, Thailand.
Department of Oral and Maxillofacial Surgery, Mahidol University, Bangkok, Thailand.
Am J Orthod Dentofacial Orthop. 2021 Jun;159(6):836-851. doi: 10.1016/j.ajodo.2020.05.016. Epub 2021 Apr 8.
Interdisciplinary treatment for patients with Treacher Collins syndrome is challenging because of the rarity of the condition and the wide variety of phenotypic expression. A 23-year-old male was diagnosed with Treacher Collins syndrome with a history of severe obstructive sleep apnea. He presented with a Pruzansky-Kaban classification grade I mandible, skeletal type II pattern with a hyperdivergent mandibular plane, severe convex profile, and Class II malocclusion with a missing mandibular incisor. Improvement of facial esthetics was achieved by a combination of orthodontics, mandibular distraction osteogenesis, and 2-jaw maxillomandibular advancement surgery. Presurgical orthodontic treatment involved permanent tooth extraction to relieve severe crowding, and Class III mechanics were employed to increase overjet. Correction of mandibular hypoplasia by increasing ramal height and the mandibular length was done by intraoral mandibular distraction osteogenesis. Counterclockwise rotation of the mandibular plane angle and a Class III occlusion with negative overjet were achieved after mandibular distraction osteogenesis. A postdistraction posterior open bite was maintained with a biteplane during the consolidation period. Subsequently, 2-jaw orthognathic surgery was performed. LeFort I osteotomy was done for maxillary advancement to correct an anterior crossbite, eliminate canting, and reestablish occlusal contact at the mandibular occlusal plane. Bilateral sagittal split ramus osteotomy was done to correct the residual mandibular deviation. A genioplasty was also performed to improve chin projection. Postoperatively, the oropharyngeal airway was enlarged. The patient's facial profile and obstructive sleep apnea problem were improved as a result of advancement and counterclockwise rotation of the maxillomandibular complex.
联合治疗特雷彻·柯林斯综合征患者颇具挑战性，因为该病较为罕见，且表型表现多样。一名 23 岁男性患者被诊断为特雷彻·柯林斯综合征，伴有严重阻塞性睡眠呼吸暂停。他存在 Pruzansky-Kaban 分类Ⅰ级下颌，矢状骨型Ⅱ类伴下颌平面明显后下倾，严重凸面型，以及上颌前突、下颌切牙缺失的Ⅱ类错颌。通过正畸、下颌骨牵引成骨术和双颌正颌手术联合治疗，改善了患者的面部美观。术前正畸治疗采用拔牙以解除重度拥挤，采用Ⅲ类矫治机制以增加覆颌。采用口内下颌骨牵引成骨术增加下颌升支高度和长度来矫正下颌骨发育不良。下颌骨牵引成骨术后，下颌平面逆时针旋转，覆颌变为Ⅲ类，且覆颌为负性。在固位期，使用𬌗垫保持牵引后后牙开𬌗。随后，进行双颌正颌手术。行 LeFort I 截骨术以矫正前牙反颌、消除倾斜、并在下颌牙合平面重建咬合接触。行双侧下颌升支矢状劈开截骨术以矫正残余下颌偏斜。同期行颏成形术以改善颏部突度。术后，口咽气道扩大。上颌骨和下颌骨复合体的前徙和逆时针旋转改善了患者的面部轮廓和阻塞性睡眠呼吸暂停问题。
