Jha Kanistika, Adhikari Manoj
Department of Orthodontics, College of Medical Sciences, Chitwan, Bharatpur, Nepal.
Department of Oral and Maxillofacial Surgery, Nepalese Army Institute of Health Sciences, College of Medicine, Sanobharyang, Kathmandu, Nepal.
Int J Surg Case Rep. 2022 Jan;90:106687. doi: 10.1016/j.ijscr.2021.106687. Epub 2021 Dec 21.
Transverse maxillary deficiency is one of the most detrimental problems to midfacial growth and the integrated dentoalveolar structures. Early diagnosis and proper treatment of such cases is most important to maintain the balance between the basal bones and stable occlusion.
In our case, a 17-year-old male had irregular upper front teeth with an unpleasant smile. Detail examination revealed a symmetrical face with an orthognathic profile, mild malar deficiency, competent lips, asymmetrical arches, Class I molar and canine relationships bilaterally. Crowding was present in the upper anterior arch with 2 mm of anterior open bite and posterior cross bite present in the premolar region and molar region bilaterally. Lefort-1 osteotomy, midpalatal split, pterygomandibular disjunction without down fracture was done. The HYRAX appliance was cemented. Distraction started after four days of surgery. One mm distraction per day was done for 10 days. The patient was transferred to fixed orthodontic treatment to relive the anterior crowding. Records were taken after 1 year of follow up and analyzed. Skeletal relationships were in harmony. Dental crowding, anterior open bite and posterior crossbite were corrected.
The zygomatic buttress and the pterygomaxillary junction are considered as the critical areas of resistance for maxillary expansion. Literature claims lefort-1 osteotomy in combination with palatal distraction results in more displacement and less stress in the maxilla.
SARPE has proved to be clinically effective and stable for the correction of transversely deficient maxilla after cessation of growth in adult patients.
上颌横向发育不足是对中面部生长及牙-牙槽结构整体影响最为不利的问题之一。对此类病例进行早期诊断和恰当治疗对于维持基骨与稳定咬合之间的平衡至关重要。
在我们的病例中，一名17岁男性上前牙不齐，笑容不佳。详细检查发现面部对称，侧貌正常，轻度颧骨发育不足，唇部功能正常，牙弓不对称，双侧磨牙及尖牙关系为Ⅰ类。上颌前牙弓存在拥挤，有2毫米的前牙开合，双侧前磨牙区及磨牙区存在后牙反合。进行了LeFort-1截骨术、腭中缝劈开术、翼下颌分离术且未进行下折。粘结了Hyrax矫治器。术后4天开始牵引。每天牵引1毫米，持续10天。患者转至固定正畸治疗以解除前牙拥挤。随访1年后进行记录并分析。骨骼关系协调。牙列拥挤、前牙开合及后牙反合均得到纠正。
颧骨支柱和翼上颌连接部被认为是上颌扩弓的关键抗力区。文献表明LeFort-1截骨术联合腭部牵引可使上颌产生更多位移且应力更小。
对于成年患者生长停止后上颌横向发育不足的矫治，骨缝牵张成骨术已被证明在临床上有效且稳定。
