两种外置式牵引治疗严重上颌发育不全

Analysis of Two External Distraction for Correction of Severe Maxillary Hypoplasia

目的:探讨两种外置式牵引治疗严重上颌发育不全的效果。方法:使用自行设计制作的颌骨牵引装置,在全麻下行LeFortⅡ型截骨,将牵引钩置入鼻底或梨状孔侧缘,从鼻孔引出,对8例严重上颌发育不全成年患者前牵引治疗,其中3例采用面弓弹性前牵引,5例采用坚固外固定支架牵引,治疗前后拍摄定位头颅侧位片测量分析。结果:采用坚固外固定支架前牵引治疗的5例患者按术前设计的要求顺利完成牵引成骨,患者咬合关系和软组织侧貌改变明显,上颌平均前移11.6mm。面弓弹性前牵引的3例患者中,1例达到预期效果,2例弹性牵引后效果不明显改为坚固外固定支架前牵引后达到效果,其中1例由于额部因长期压迫出现局部缺血改换为坚固外固定支架。结论:RED是治疗严重上颌后缩畸形的有效方法,对唇腭裂严重上颌发育不全患者慎用面弓弹性牵拉。

Objective： To study the clinical effects of maxillary distraction made from different external distraction de- vices for treatment of maxillary hypoplasia. Methods： Eight cases with class Ⅲ maxillary deficiencies were treated with midface skeleton protraction. Following Le Fort Ⅱ osteotomy, traction hook was hitched to the floor or side of apertura piri- forms. Through the nostrils, it connected with external distraction device, Five cases underwent traction with rigid external distraction device. 3 cases underwent face bow distraction with elastics. Mean treatment time was three months. Lateral cephalometric films were taken and analyzed before and after treatment. Results： Five patients undergoing rigid external distraction were successfully achieved lengthening of their jaws. The occlusal relationship and soft tissue profile improved significantly. The mean effective horizontal advancement of the maxilla was 11.6mm. For patients in the face bow distrac- tion group, only one patient successfully accomplished distraction. Tow cases were replaced by rigid external distraction for unsuccessful results. In one case, forehead ischemia appeared gradually during face bow distraction, so elastic distraction was abandoned for rigid external distraction, Conclusion： Rigid external maxillary distraction is an effective method for cor- rection severe maxillary hypoplasia. It should be cautious to use face bow distraction in patients with cleft lip -palate and severe maxillary hypoplasia.