下颌升支牵引成骨矫治半侧颜面发育不全

Distraction osteogenesis of the mandibular ramus in hemifacial microsomia

目的探讨下颌升支牵引成骨在矫治半侧颜面发育不全中的应用价值。方法1999至2006年采用下颌升支牵引成骨矫治半侧颜面发育不全畸形患者15例，其中幼儿及青少年患者12例，成年患者3例，部分患者一期或二期采用了上颌LeFortⅠ型截骨术、健侧下颌升支矢状劈开截骨术、颏成形术及游离肩胛皮瓣移植修复术等。结果所有患者术后均顺利完成牵引治疗，平均牵引距离21．25mm（15～40mm）。临床及影像学观察新骨形成良好后去除牵引器。术后患侧面部丰满度和面部对称性均得到明显提高，咬合关系均较术前明显改善，咬合平面基本摆正。无一例出现感染或成骨不良等并发症。未出现永久性下牙槽神经功能损伤症状。结论下颌升支牵引成骨技术是矫治严重半侧颜面发育不全的较好方法，且矫治效果优于传统正颌外科。

Objective To study the application of distraction osteogenesis（DO） of the mandibular ramus in hemifacial microsomia. Methods From 1999 to 2006, 15 patients with hemifacial mierosomia were treated with DO of the ramus, including 12 cases of children and juveniles, 3 cases of grown-ups. Maxillary Le Fort Ⅰ osteotomy, unilateral sagittal split ramus osteotomy, genioplasty and free scapular flaps were selected to perform on the first or secondary stage of treatment. Results Successful distraction was achieved in all patients with an average distraction distance of 21.25 ram. The distractor was removed after consolidation proved by clinical examination and X-ray. Facial apperance and and oeclusal relationship were improved greatly. The occlusal plane was almost normal. There was no infection, malunion or permanent injury of inferior alveolar nerve. Conclusions DO of the ramus is very effective for the correction of severe hemifacial micorsomia. It has much better therapeutic effect than traditional orthognathic procedures.