下颌骨牵引成骨配合正颌手术矫治成人半侧颜面短小畸形

摘要

目的 探讨下颌骨牵引成骨配合正颌手术治疗成人严重半侧颜面短小畸形的方法.方法 将患者三维CT重建数据导入Mimics软件进行手术模拟设计,确定截骨线的位置、牵引向量以及拟牵引的长度并制作手术导板.一期手术行口外入路内置式牵引器置入术,术后5～7d开始骨牵引,延长速度为1 mm/d,牵引结束后,牵引器保留3～6个月.二期手术采用上颌骨Le Fort Ⅰ型截骨,将上颌骨旋转、下降,关闭患侧开颌,采用下颌骨外板植入到上颌截骨下降后的间隙并妥善固定,以保证骨质愈合、维持上颌截骨下降后的稳定性、增加患侧上颌骨的骨体积以增加患侧的丰满度.颏部仍遗留偏斜或形态位置不佳者,同时行颏成形术予以调整.结果 2009年9月至2012年3月,采用上述方法矫治9例半侧颜面短小畸形患者,术后面部对称性、咬合关系趋近正常,效果满意.8例未出现任何并发症,1例上颌切口感染,经清创换药后延迟愈合,未影响面部形态及咬合关系.结论 下颌骨牵引成骨配合正颌手术是矫治成人半侧颜面短小畸形的有效方法.%Objective To study the combination of Mandibular distraction and orthognathic techniques for the reconstruction of adult hemifacial microsomia.Methods The three-dimensional CT reconstruction data was used with Mimics for preoperation design.The osteotomy location,distrction vector,distraction distance were decided before operation with a surgical guider.At the first stage,internal distractor was implanted after ostetomy through an extra-oral approach.The distraction begun 5-7 days after operation with a frequency of 1 mm/day.After distraction,the distractor was maintained for 3-6 months.At the second stage,the distractor was removed.Le Fort Ⅰ osteotomy was performed in order to correct the cross-bite and improve the facial contour.Usually,bone graft was inserted into the gap after Le Fort Ⅰ osteotomy.The genioplasty was also performed if necessary.Results 9 cases of adult hemifacialmicrosomia with severe mandibular deviation were treated.The facial asymmetry were improved greatly.1 patient suffered an wound infection in the maxillary region after Le Fort Ⅰ osteotomy and healed uneventfully with wound irrigation.Conclusions Mandibular distraction combined with orthognathic surgery is an effective procedure for adult hemifacial microsomia with complicated mandibular hypoplasia.