Jolly Lisa, Sudduth Jack D, Marquez Jessica L, White Michelle, Collar-Yagas Lucia, Yamashiro Duane, Siddiqi Faizi, Gociman Barbu
From the University of Utah Hospital, Department of Surgery, Division of Plastic Surgery, Salt Lake City, Utah.
Plast Reconstr Surg Glob Open. 2023 May 10;11(5):e4976. doi: 10.1097/GOX.0000000000004976. eCollection 2023 May.
LeFort I, II, and III osteotomies are commonly used in complex craniofacial reconstruction. Patients requiring these procedures typically have a craniofacial cleft, other congenital craniofacial deformities, or severe facial trauma. Both the cleft and traumatized palate have poor bony support, which leads to possible complications when the disimpaction forceps are used during the downfracture of the maxilla. Such potential complications include trauma or formation of a fistula of the palatal, oral, or nasal mucosa; trauma to adjacent teeth; and fracture of the palate and alveolar bone. To help prevent these complications, we developed a custom disimpaction splint. The splint is designed to cover the palate and occlusal surfaces to increase retention and minimize splint movement during the maxillary downfracture portion of the surgical procedure. The base of the splint is fabricated from a two-layered biocryl material, and the palatal area is built with soft-cushion rebase material. This allows for a stable grip of the disimpaction forceps blades and provides protective coverage of the cleft, traumatized palate, or alveolar bone graft site during the downfracture. The custom maxillary disimpaction splint has been routinely used in our clinic from September 2019 to the present for LeFort osteotomies in patients with a compromised primary palate. No surgical complications related to the maxillary downfracture have been noted during this period of time. We conclude that the routine use of a custom maxillary disimpaction splint can result in improved outcomes and decreased complications of LeFort osteotomy procedures in patients with cleft and traumatized palate.
勒福 I 型、II 型和 III 型截骨术常用于复杂的颅面重建。需要进行这些手术的患者通常患有颅面裂、其他先天性颅面畸形或严重面部创伤。腭裂和创伤性腭裂的骨支撑都很差，这在对上颌骨进行下行折断时使用去骨钳时会导致可能的并发症。此类潜在并发症包括腭、口腔或鼻黏膜的创伤或瘘管形成；相邻牙齿的创伤；以及腭部和牙槽骨骨折。为了帮助预防这些并发症，我们开发了一种定制的去骨夹板。该夹板设计用于覆盖腭部和咬合面，以增加固定并在手术过程的上颌下行折断部分将夹板移动降至最低。夹板的底部由两层生物丙烯酸材料制成，腭部区域用软衬垫重衬材料构建。这使得去骨钳刀片能够稳定握持，并在下行折断过程中为腭裂、创伤性腭部或牙槽骨移植部位提供保护性覆盖。自 2019 年 9 月至今，我们诊所已常规使用定制的上颌去骨夹板对原发性腭部受损的患者进行勒福截骨术。在此期间，未发现与上颌下行折断相关的手术并发症。我们得出结论，常规使用定制的上颌去骨夹板可改善患有腭裂和创伤性腭部患者的勒福截骨术的效果并减少并发症。
