Posnick J C, al-Qattan M M, Armstrong D
Department of Surgery, Georgetown University Medical Center, Washington D.C., USA.
Plast Reconstr Surg. 1996 May;97(6):1118-28. doi: 10.1097/00006534-199605000-00005.
This study evaluated the presence of extradural dead space following a monobloc or facial bipartition osteotomy and examined its natural history and relationship to postoperative infection and the presence of a ventriculoperitoneal shunt at the time of osteotomy in a consecutive series of patients with craniofacial dysostosis, frontonasal dysplasia, midline cranio-orbital clefts, and orbital hypertelorism. Only patients followed for at least 1 year were included in the study (range 1.3 to 5.5 years). The 23 patients studied were divided into three groups: 10 patients (mean age 9 years) underwent a monobloc osteotomy with advancement, 7 (mean age 8 years) a facial bipartition osteotomy with advancement, and 6 (mean age 7 years) a facial bipartition osteotomy without advancement. Standard craniofacial computed tomographic (CT) scans were obtained for each patient early after surgery (within 2 weeks in 13 patients and at 6 to 8 weeks in 10 patients) and again 1 year after surgery in every case. The extradural dead space was measured from a reproducible axial CT scan slice for each patient at each postoperative interval. An initial dead space was documented in the retrofrontal region of the anterior cranial fossa when the reconstruction incorporated forward projection of the osteotomy parts. This space was found to be obliterated by the expanded brain by 6 to 8 weeks in the patients examined by CT scan slice for each patient at each postoperative in all patients. Perioperative complications also were documented. The presence of a ventriculoperitoneal shunt at the time of osteotomy (7 of 23 patients) did not increase the risk of complications or alter the pattern of dead space closure after operation. Two patients developed infectious complications that were managed without long-term consequences.
本研究评估了整块或面部二分截骨术后硬膜外死腔的存在情况，并在一系列连续性颅面骨发育不全、额鼻发育不良、中线颅眶裂和眶距增宽患者中，研究了其自然病程、与术后感染的关系以及截骨时脑室腹腔分流管的存在情况。仅纳入随访至少1年的患者（范围为1.3至5.5年）。所研究的23例患者分为三组：10例患者（平均年龄9岁）接受了整块截骨并前移，7例（平均年龄8岁）接受了面部二分截骨并前移，6例（平均年龄7岁）接受了面部二分截骨但未前移。每位患者在术后早期（13例患者在2周内，10例患者在6至8周）均接受了标准的颅面计算机断层扫描（CT），并且所有患者在术后1年再次进行扫描。在每个术后时间间隔，从每位患者可重复的轴向CT扫描切片测量硬膜外死腔。当重建包括截骨部分的向前投影时，在前颅窝的额后区域记录到初始死腔。在所有接受CT扫描切片检查的患者中，该空间在术后6至8周被扩张的脑组织填满。还记录了围手术期并发症。截骨时存在脑室腹腔分流管（23例患者中的7例）并未增加并发症风险，也未改变术后死腔闭合模式。2例患者发生感染性并发症，经处理后未产生长期后果。
