Dufresne C, Richtsmeier J T
Division of Plastic Surgery, Georgetown University, Washington, DC., USA.
J Craniofac Surg. 1995 Jul;6(4):270-81. doi: 10.1097/00001665-199507000-00003.
Craniofacial surgery is a multidisciplinary specialty that often uses the expertise of many specialists including surgeons, orthodontists, geneticists, and anthropologists. The clinical experience gained by their collaboration enables predictions to be made of the ultimate success of the reconstructive surgery. Various patterns among surgical outcomes are noted as greater experience is gained. These observations prompted the following questions: Is there a way to classify patients according to surgical results? What factors underlie a successful response to surgery? In a clinical setting, we are faced with a spectrum of presentations of craniofacial dysmorphology. We propose that the results of surgical correction may be based on the cause of the condition and not necessarily on the degree or character of the dysmorphology. Craniofacial dysmorphologies are often grouped under the terms deformation, malformation, disruption, dysplasia, or syndrome. Our hypothesis is that a categorization of craniofacial dysmorphology can be proposed on the basis of the response of the individual to surgery. We propose that such a classification reflects real differences in cause. A poor response to surgery reflects a condition that includes a growth disorder. Alternatively, cases that respond best to surgery are those in which the growth process is not affected. In the latter cases, a dysmorphic face is surgically transformed into an acceptable morphology, and normative growth vectors maintain or improve postoperative facial appearance. It is our belief that the physiological differences underlying our categorization scheme have to do with embryological timing of insults or specific components of the ontogenic process. The divergence in the response to surgery among patients relates directly to the role of the growth process in the various types of dysmorphologies.
颅面外科是一个多学科专业，经常需要许多专家的专业知识，包括外科医生、正畸医生、遗传学家和人类学家。他们合作所积累的临床经验有助于预测重建手术最终的成功与否。随着经验的增加，人们注意到手术结果存在各种模式。这些观察引发了以下问题：有没有一种方法可以根据手术结果对患者进行分类？手术成功的因素是什么？在临床环境中，我们面对的是一系列颅面畸形的表现。我们认为，手术矫正的结果可能取决于病情的原因，而不一定取决于畸形的程度或特征。颅面畸形通常被归类为变形、畸形、中断、发育异常或综合征等术语。我们的假设是，可以根据个体对手术的反应对颅面畸形进行分类。我们认为这种分类反映了病因的实际差异。对手术反应不佳反映出一种包括生长障碍的病情。相反，对手术反应最佳的病例是那些生长过程未受影响的病例。在后一种情况下，畸形的面部通过手术转变为可接受的形态，正常的生长向量维持或改善术后的面部外观。我们相信，我们分类方案背后的生理差异与损伤的胚胎学时间或个体发育过程的特定组成部分有关。患者对手术反应的差异直接与生长过程在各种类型畸形中的作用有关。
