高位Le FortⅠ型截骨同期牙槽嵴裂植骨矫治唇腭裂术后面中部畸形

HIGH LEVEL LE FORT Ⅰ OSTEOTOMY AND BONE GRAFTING FOR CORRECTION OF SECONDARY MID-FACE DEFORMITIES IN CLEFT PATIENTS

目的 探讨联合应用高位Le Fort Ⅰ型截骨同期牙槽嵴裂植骨矫治唇腭裂术后面中部畸形的可行性。方法2002年1月～2005年1月，共收治10例唇腭裂术后面中部畸形患者，男4例，女6例。年龄16～32岁。单侧唇腭裂8例，双侧2例。影像学检查均有继发面中部畸形的主要表现。均采用高位Le Fort Ⅰ型截骨和牙槽嵴裂自体髂骨游离移植一期手术矫正。高位Le Fort Ⅰ型截骨的截骨线在上颌骨前壁比常规Le Fort Ⅰ型截骨线高，最高可达眶下孔下5mm左右，水平截开至颧牙槽嵴处再弧形转向下后方。结果术后伤口均I期愈合。复查头部X线片，所有患者上颌骨位置均得到明显改善。随访6～24个月，牙弓外形良好，X线片示无明显骨质吸收，植骨区密度与周围接近。10例均获得满意面容，其中9例获得良好的牙骀关系。结论高位Le Fort Ⅰ型截骨术不仅可前移上颌骨，还可前移部分眶下区及整个鼻旁区和鼻底，更明显地改善畸形。同期行牙槽嵴裂自体髂骨游离移植，可减少手术次数、降低费用、获得理想效果，是矫治唇腭裂术后面中部继发畸形的一种有效方法。

Objective To explore the feasibility of combining high level Le Fort Ⅰ osteotomy with bone grafting in the same operation for correction of secondary mid-face deformities in cleft patients. Methods From January 2002 to January 2005, 10 patients suffering from secondary mid-face deformities were treated. There were 4 males and 6 females, aged from 16 to 32 years. The unilateral cleft was involved in 8 patients and the bilateral cleft in 2 patients. All patients received combining high level Le Fort Ⅰ osteotomy with bone grafting in the same operation. The horizontal corticotomy of high level Le Fort Ⅰ osteotomy on anterior wall of maxillary bone is higher than that of traditional Le Fort Ⅰ osteotomy, it is only 5 mm close to infraorbital foramen. Results All 10 patients were satisfied with their appearances after operation. Dental articulation was improved greatly in 9 patients. With an X-ray re-examination, maxillary was returned to normal position in all patients. After a follow up from 6 months to 2 years, dental arch had good appearance. The X-ray films showed no obvious bone absorption. The density of grafting bone was approximation to the normal bone. Conclusion High level Le Fort Ⅰ osteotomy can make not only maxillary advance, but also regions of lateral and floor of nose and partial infraorbital region advance. Combining with bone grafting in the same operation can decrease the frequency of operation, save the treatment expense and obtain an ideal effect. So it is an effective method for correction of the secondary mid-face deformities in cleft patients.