McCarthy J G, Staffenberg D A, Wood R J, Cutting C B, Grayson B H, Thorne C H
New York University Medical Center Institute of Reconstructive Plastic Surgery, N.Y., USA.
Plast Reconstr Surg. 1995 Sep;96(4):978-81. doi: 10.1097/00006534-199509001-00034.
It has been demonstrated that distraction osteogenesis is an effective clinical tool with applications for the entire human skeleton. Therapeutic exploitation in the correction of the asymmetrical and hypoplastic mandible has been reported previously. However, the main criticism of this technique has been the residual cutaneous scars resulting from the surgical incision and the path of the expansion device. In order to obviate the need for skin incisions, we have developed and demonstrated the feasibility of a miniaturized mandibular bone lengthener that is suitable for intraoral placement. Ten growing mongrel dogs were studied. Under general anesthesia, a buccal mucosal incision was made along the oblique line, and the body and ramus of the mandible were exposed in a supraperiosteal plane. Two 2.0-mm half-pins were placed percutaneously in the area of the angle of the mandible, and two other pins were placed 3.5 cm anteriorly. The clamps of the lengthening device were then attached to the half-pins in an intraoral position. An osteotomy was made by connecting percutaneously made drill holes between the clamps in a line positioned posterior to the third molar. The mucosa was closed loosely over the device. Distraction was commenced on the eighth postoperative day. The results were assessed with pre- and post-lengthening photographs, cephalograms, and CT scans with three-dimensional reconstruction. All animals demonstrated a contralateral cross-bite. The newly developed bone also was examined histologically. The intraoral method of mandibular lengthening offers the same advantages of extraoral lengthening but without the need for a cutaneous incision and resulting scar.
已经证明，牵张成骨是一种有效的临床工具，可应用于整个人体骨骼。此前已有报道称其在矫正不对称和发育不全的下颌骨方面有治疗用途。然而，该技术的主要批评在于手术切口和扩张装置路径会留下皮肤瘢痕。为了避免皮肤切口的需要，我们开发并证明了一种适用于口腔内放置的小型化下颌骨延长器的可行性。对10只生长中的杂种犬进行了研究。在全身麻醉下，沿斜线做颊黏膜切口，在骨膜上平面暴露下颌骨体和下颌支。在下颌角区域经皮置入两根2.0毫米的半针，在前方3.5厘米处再置入另外两根针。然后将延长装置的夹具在口腔内位置连接到半针上。通过在夹具之间经皮钻孔并在第三磨牙后方的一条线上连接来进行截骨术。黏膜在装置上方松散缝合。术后第8天开始牵张。通过牵张前后的照片、头颅侧位片和三维重建的CT扫描来评估结果。所有动物均出现对侧反咬合。还对新形成的骨进行了组织学检查。口腔内下颌骨延长方法具有与口腔外延长相同的优点，但无需皮肤切口及由此产生的瘢痕。
