Monobloc四段式截骨牵引治疗眶距增宽症合并面中部发育不良

Four-Segments Monobloc Osteotomy and External Distraction in the Treatment of Orbital Hypertelorism with Midface Hypoplasia

目的Monobloc四段式截骨及外置式牵引,治疗1例重度眶距增宽症合并面中部发育不良患者,总结手术方法和经验体会。方法对1例重度眶距增宽症合并面中部发育不良患者行颅内外联合径路手术。额部颅骨开窗,Monobloc截骨游离整个颅面部,颧颌部水平截骨、眶鼻部矢状截骨,将颅面骨分为额部、双侧眶颧部、颧颌部4段完全游离的骨块,额部重塑,双侧眶颧部内收,肋骨隆鼻,颧颌部外置式牵引并固定3个月。结果手术顺利,拆除牵引器1个月后,影像学测量显示IOD为28.6 mm、面中部前移约9 mm,患者眶距增宽、面中部凹陷、反牙合均得到有效纠正,但鼻形态需进一步修整。结论Monobloc四段式截骨及外置式牵引治疗重度眶距增宽症伴面中部发育不良,能一次性纠正眶距过宽、面中部凹陷、反牙合,安全有效。

Objective To explore the efficacy of the modified monobloc osteotomy method and external distraction in the treatment of orbital hypertelorism with midfaee hypoplasia. Methods A 19-year-old girl was performed modified monobloc osteotomy through combined intra and extra cranial way. The craniofaeial bone was divided into frontal, two orbital-malar and malar-maxillary segments. The frontal bone was reshaped and the interorbital distance （IOD） got reduced. Self-rib was implanted to rebuild nose. The external distractor was used to advance the malar-maxillary part and the consolidation period lasted for 3 months. Results Well eraniofacial appearance was achieved in this case. The post-operation IOD was 28.6 mm. The real distraction distance of facial bone was 9 mm documented by 3D-CT. However, additional rhinoplasty would be nee- essary for better nasal appearance. Conclusion The modified Monobloe osteotomy method could be applied for severe or- bital hypertelorism with midface hypoplasia. It is a safe technique and can correct orbital hypertelorism, depression of mid- face and mandible prognathism.