上下颌骨同期牵张成骨联合二期正颌手术矫治成人半侧颜面短小畸形

Simultaneous distraction osteogenesis of the maxilla and mandible combined with second-stage orthognathic surgery for correction of hemifacial microsomia in adults

目的探讨上颌骨与患侧下颌骨同期牵张成骨联合二期正颌手术治疗成人半侧颜面短小畸形的临床效果,为临床提供参考。方法 2006年—2013年接受了上下颌骨同期牵张成骨和二期正颌手术治疗的成人半侧颜面短小畸形患者12例,根据患者具体情况,采取上颌骨与患侧下颌骨牵张成骨联合二期正颌手术。测量患者治疗前后患侧与健侧下颌升支高度比、颏点偏移距离、(牙合)平面倾斜角度3个指标的变化情况,并结合临床照片评估其治疗效果。结果所有患者术后均未出现明显并发症,术后美观效果良好,面型和咬合关系明显改善。头影测量结果显示,术后患者患侧与健侧下颌升支高度比平均提高23.83%(t=11.658,P<0.001);颏点偏移距离得到纠正,偏移的颏点平均向中线回移6.63 mm(t=13.042,P<0.001);(牙合)平面倾斜角度得到改善,平均向水平面回复8.83°(t=15.358,P<0.001)。结论应用上下颌骨同期牵张成骨联合二期正颌手术矫治成人半侧颜面短小畸形,可获得满意的临床及美学效果,具有临床推广价值。

Objective To explore the clinical effect of simultaneous distraction osteogenesis of the maxilla and affected mandible combined with second-stage orthognathic surgery for the treatment of adult hemifacial microsomia to provide a reference for clinical practice. Methods Twelve adult patients with hemifacial microsomia who underwent simultaneous distraction osteogenesis and second-stage orthognathic surgery from 2006 to 2013 were enrolled. Distraction osteogenesis of the maxilla and malformed lateral mandible and second-stage orthognathic surgery were performed according to each patient′s specific conditions. The height ratio of the mandibular ramus of the affected side to the contralateral side, the shift distance of the chin point and the inclination angle of the screw plane were measured before and after the operation, and the therapeutic effect was evaluated with clinical photographs. Results No patients had obvious complications after the operation, the postoperative aesthetic effect was good, and the relationship between the facial shape and occlusion was significantly improved. The cephalometric measurement showed that the height ratio of the mandibular ramus of the affected side to the contralateral side was increased by 23.83%(t=11.658, P0.001), the deviation distance of the chin was corrected, and the chin point moved back to the midline by 6.63 mm(t=13.042, P0.001) on average, and the inclination angle of the occlusal plane was improved and returned to the horizontal plane by8.83°(t=15.358, P0.001) on average. Conclusion The application of simultaneous distraction osteogenesis of the maxilla and mandible combined with secondary orthognathic surgery for the treatment of adult hemifacial microsomia can obtain satisfactory clinical and aesthetic results and has clinical value.