Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Oral and Maxillofacial Surgery, Chutoen General Medical Center, Kakegawa, Japan.
Nagoya J Med Sci. 2023 Feb;85(1):70-78. doi: 10.18999/nagjms.85.1.70.
This study was conducted to evaluate the postsurgical stability of Le Fort I osteotomy using zygomatic buttress internal fixation alone with no piriform aperture internal fixation. Patients with maxillary retrognathia and mandibular prognathism underwent the Le Fort I osteotomy with a bilateral sagittal split ramus osteotomy. In group I, fixation was accomplished using titanium plate and screws placed at the piriform aperture and the zygomatic buttress (4 plates). In group II, fixation was accomplished using titanium plate and screws placed at the zygomatic buttress (2 plates). Lateral cephalometric radiographs were taken preoperatively (T1), immediately after surgery (T2), and at 6 months to 1 year (T3) to evaluate skeletal movement. In total, 32 patients were included in this study. None of the patients had wound infection, dehiscence, bone fragment instability, and long-term malocclusion. Regarding point A and the posterior nasal spine (PNS), vertical and horizontal relapse in groups I and II did not differ significantly. In most hospitals, the maxilla was fixed using four plates (piriform aperture and zygomatic buttress); however, within the limitations of the study, the choice of the number of plates for osteosynthesis following Le Fort I osteotomy and repositioning of the maxilla can be left to the discretion of the surgeon without putting the patients at risk for increased relapse by careful intraoperative management.
本研究旨在评估单纯使用颧骨支撑内固定行 Le Fort I 截骨术后的稳定性，而不进行梨状孔内固定。上颌后缩和下颌前突的患者接受 Le Fort I 截骨术和双侧矢状劈开下颌骨截骨术。在 I 组中，使用钛板和螺钉固定在梨状孔和颧骨支撑处（4 块板）。在 II 组中，使用钛板和螺钉固定在颧骨支撑处（2 块板）。在术前（T1）、术后即刻（T2）和 6 个月至 1 年（T3）拍摄侧位头颅侧位片，以评估骨骼运动。共有 32 例患者纳入本研究。所有患者均无伤口感染、裂开、骨片不稳定和长期咬合不正。关于 A 点和后鼻棘（PNS），I 组和 II 组的垂直和水平复发无显著差异。在大多数医院，上颌骨使用 4 块板（梨状孔和颧骨支撑）固定；然而，在本研究的限制范围内，Le Fort I 截骨术后和上颌骨重新定位的骨合成板的数量选择可以由外科医生自行决定，只要通过仔细的术中管理，不会增加复发的风险即可。
