RIF技术在陈旧性面中份骨折所致牙颌面畸形的外科修复与功能重建中的应用

目的：探求复杂的陈旧性面中份骨折后其牙、颌、面畸形修复与功能重建的有效治疗方法。方法：对2000年-2003年间收治的23例复杂的陈旧性面中份骨折病例，术前进行影像学分析和模型外科设计，并取得上颌骨分块截骨术后的定位舍板，以预测和指导手术。手术采用口内切口，通过Le FortⅠ型或Le FortⅡ型截骨术，将上颌骨截断降下，按模型材料设计要求将上颌骨分块，并将分块后的上颌骨块固定于合板上。行上、下颌颌间栓结，待确定恢复正常咬合关系后，用微型夹板行上颌骨坚固内固定(rigid internal fixation，RIF)，或是辅以头皮冠状切口，将错位愈合的颧骨、颧弓复住，固定。结果：本组病例一周后伤口均Ⅰ期愈合拆线，2-3周拆除颌间牵引固定，骨块固定，咬合关系正常，颜面外形恢复满意。结论：正颌外科术式或辅以其他术式以及RIF技术的应用是治疗复杂的陈旧性面中份骨折的有效方法。     

上颌骨矢状骨折的临床研究

目的：探讨上颌骨矢状骨折的手术治疗方法,方法：收集2001年3月-2009年10月收治的45例上颌骨矢状骨折病例,通过LeFortⅠ型截骨术治疗,对手术效果进行分析。结果：Le FortⅠ型截骨术治疗上颌骨矢状骨折均获得良好疗效,患者面型和咬合关系恢复满意,无严重手术并发症。结论：LeFortⅠ型截骨术是治疗上颌骨矢状骨折的有效手术方法,术前应依照正颌外科原则进行模型外科准备,术中应同期进行其它面骨的复位固定。     

正颌外科技术在颌面部陈旧性骨折中的应用

目的:探讨正颌外科技术在颌面部陈旧性骨折中的临床应用,以寻找恢复面部外形和正常咬合关系的方法.方法:对20例颌面部陈旧性骨折患者,术前经三维CT重建、头影测量分析、模型外科等确定截骨部位及手术方案.对有咬合关系错乱者,制作定位咬合导板,然后采用正颌外科技术在预定部位截骨或截开错位愈合骨段.恢复骨段连接、咬合关系及面形后,予以坚强内固定.结果:20例患者术后均恢复了正常面形,咬合关系满意,其中4例行上颌骨截开者,上颌骨前外侧壁发生骨不愈合,2例出现口腔上颌窦瘘.结论:利用正颌外科设计程序和截骨手段结合坚强内固定技术治疗颌面骨陈旧性骨折,在将错位骨愈合的骨段重新复位或设计骨段移动到位的情况下,可恢复良好的面部外形和最大限度地改善咬合关系.     

�����ѻ����ǻ��ε�����������

唇腭裂患者常伴有不同程度的颌骨畸形,需要进行正颌外科治疗,手术方法包括常规正颌外科手术和上颌骨牵引成骨术。常规正颌外科手术最常用的是Le Fort Ⅰ型截骨术,适用于轻至中度的上颌后缩畸形,有时还需要配合双侧下颌升支矢状劈开截骨术(BSSRO)和颏成形术,以进一步改善面型和咬合关系。上颌骨牵引成骨术可采用外置式或内置式牵引器进行,截骨线可根据治疗需要采用Le Fort Ⅰ型截骨线或上颌前部截骨线。正颌外科和牵引成骨术各有其优点和局限性,如何选择合适的治疗方案应综合分析患者病情及医生临床经验,并与患者充分沟通,才能取得良好的矫治效果。     

Le Fort Ⅰ型截骨术在唇腭裂正颌外科中的应用与评价

目的:观察分析Le Fort Ⅰ型截骨术在唇腭裂正颌外科中的应用效果.方法:回顾2004年3月至2006年12月武汉大学口腔医学院口腔颌面外科收治的唇腭裂患者的临床资料,并进行总结与分析,所有患者均进行了以Le Fort Ⅰ型截骨术为主的正颌外科治疗.结果:共收集相关病例16例,其中男9例,女7例,平均年龄22.4岁.术前∠SNA平均73.2°,术后LSNA平均79.5°;上颌前移距离平均8.13mm.平均随访时间7.3个月.所有患者术后面容改善明显,经正畸治疗后咬合关系满意.结论:以Le Fort Ⅰ型截骨术为主的正颌外科治疗,可以显著改善唇腭裂患者的颌骨与面容畸形.     

面中部牵引成骨结合正颌手术治疗Binder综合征

目的：Binder综合征患者有严重的面部凹陷畸形及咬合功能障碍,治疗相对困难且易复发。本研究探讨面中部牵引结合正颌手术在Binder综合征治疗中的价值。方法：4例Binder综合征患者采用改良Le Fort II型截骨术,术后利用颅骨外置式牵引器进行旋转牵引,并随时调整矢状向及垂直向的量,矫正患者面形。半年后进行正颌手术,矫正咬合关系,并随访1~2 a。结果：4例患者均顺利完成整个治疗过程,无明显并发症发生。牵引过程中无明显疼痛及不适。头影测量显示,患者面中部骨骼显著前移,凹陷畸形得以矫治。经过正颌-正畸联合治疗,获得了良好的咬合关系。结论：上颌骨Le Fort II型截骨牵引可以矫治鼻上颌骨发育不足,通过正颌手术可以矫正咬合关系,两者结合是一种较为理想的治疗Binder综合征的方法。     

改良口外须颅颌固定在上颌骨骨折中的应用

目的:探讨改良口外须颅颌固定治疗上颌骨骨折的临床效果。方法:对35例上颌骨Le FortⅡ、Ⅲ型骨折患者,先行闭合复位,恢复受伤前的咬合关系,再行改良口外须颅颌固定牵引3～4周。结果:35例Le FortⅡ、Ⅲ型骨折患者总有效率达94.2%。结论:改良口外须颅颌固定牵引治疗上颌骨骨折是一种简单易行、可靠的方法。     

计算机辅助牵引成骨术的模拟和初步评价

目的 介绍并应用计算机辅助正颌外科模拟系统（CASSOS 2001）模拟，预测上颌骨牵引成骨术，评价治疗前后的软，硬组织变化。方法 1例男性，14岁唇腭裂术后上颌严重发育不足患者，应用CASSOS 2001系统作术前头影测量分析，手术和牵引方向模拟，牵引后面型预测,实际牵引成骨治疗后的头影测量分析等，手术模拟中分别进行了Le Fort I型截骨术和Le Fort Ⅱ型截骨术的模拟。对多项头影测量作了比较。结果 牵引前后数据比较显示，面中部凹隐畸形获得了显著改善；手术模拟与实际术后结果比较显示，上颌骨Le Fort I型截骨后牵引成骨术所获得的面型改善可以达到正颌外科Le Frot Ⅱ型截骨前移后的效果。结论 上颌牵引成骨对于严重的上颌骨局部畸形，尤其是唇腭裂术后上颌骨严重发育不足，是一种极其有效的治疗方法：CASSOS 2001系统不仅为正颌外科手术，也为牵引成骨治疗提供了一种对医生和患者都有极大帮助的模拟和预测方法。     

上颌骨矢状骨折的处理

目的:探讨上颌骨矢状骨折复位内固定的方法。方法:回顾分析了15例上颌骨矢状骨折的治疗,10例术前行模型外科分析制作导板,其中8例手术中应用LeFortΙ型截骨、折断降下技术,其余病例应用了离断翼上颌连接,松解骨折片的操作;所有病例均于上颌骨前部以微型钛合金接骨板内固定。结果:15例患者术中骨折复位良好;14例关系恢复,1例术后骨折片移位。结论:正颌外科技术是治疗上颌骨矢状骨折的有效方法;矢状骨折时,上颌骨前部仅应用1枚微型钛合金接骨板固定机械抗力可能不足。     

口腔颌面部骨折微型钛板坚固内固定的临床研究

目的　临床观察应用微型钛板作骨内坚固内固定后骨折愈合情况。方法　根据自 1997— 2 0 0 2年收治的 36 0例口腔颌面骨折 (下颌骨骨折 15 2例 ;上颌骨骨折 6 8例 ;上下颌骨联合骨折 14 0 ,其中伴有颧骨颧弓骨折 6 1例 )进行微型钛板或小型钛板作骨内坚固内固定术。结果　多数病例能达到一期愈合 ,仅 2 2例伴有并发症。结论　钛板骨内坚固内固定具有良好的效果 ,术后面颌畸形得以改善 ,咬合功能恢复。     

Passive repositioning of maxillary fractures: An occasional impossibility without osteotomy

PURPOSE: To present cases where passive repositioning of maxillary fractures was not achievable during surgery, and a method to provide passive occlusal positioning in those cases. PATIENTS AND METHODS: Over a 10-year period, the maxillae of 24 patients with fractures of the maxilla could not be passively repositioned during surgery. In these cases, a Le Fort I osteotomy was performed in addition to reduction and fixation of the other midfacial fractures. RESULTS: All patients had passive restoration of their pretrauma occlusion during surgery. All patients except 1 had maintenance of their pretrauma occlusion at the last follow-up visit (6 weeks or more) following surgery. CONCLUSION: When passive positioning of the maxilla is not possible, a concomitant Le Fort I osteotomy can provide passive positioning of the occlusion.     

Navigation surgery for Le Fort 1 osteotomy in a fibrous dysplasia patient

Orthognathic surgery is sometimes performed for fibrous dysplasia to correct malocclusion or facial asymmetry. However, Le Fort 1 osteotomy for this disease is difficult because of severe anatomical abnormality. Computerassisted surgery is a rapidly developing technique in oral and maxillofacial surgery that is helping to ensure the safety of the surgery. We report a case of polyostotic craniofacial fibrous dysplasia in which two-jaw orthognathic surgery was performed using a navigation system with the Le Fort 1 osteotomy procedure. A 29-year-old woman presented with swelling and asymmetry on the right side of her face. Craniofacial fibrous dysplasia on the right side had been previously diagnosed, and she had undergone conservative surgery several times before. The disease extended to the right mandible, maxilla, and zygomatic, temporal frontal, and orbital areas, including the skull base. We first performed conservative contouring around the frontal and orbital areas, and then Le Fort I osteotomy and sagittal split ramus osteotomy to correct the asymmetry and cant of the occlusal plane. A passive infrared navigation system (Vector Vision surgical navigation system) was used for the Le Fort I osteotomy. The postoperative course was stable, and the facial asymmetry and cant of the occlusal plane improved and remained suitable 2 years after surgery. Thus, Le Fort 1 osteotomy can be performed safely in fibrous dysplasia with the aid of a passive infrared navigation system.     

Postoperative computed tomography study of pterygomaxillary separation during the Le Fort I osteotomy

Computed tomography (CT) was used postoperatively to assess the pterygomaxillary region in 12 orthognathic surgery patients who had had a Le Fort I osteotomy. Although pterygomaxillary separation was successful in all cases, in only 41.6% of the sides did fractures of the plate not occur. The incidence of low pterygoid plate fracture was 37.5% and that of high pterygoid plate fracture was 25%; 4.2% of sides showed a maxillary tuberosity fracture. Multiple fractures were observed in 8.3% of separated plates. Of 17 pterygoid plates judged clinically to be intact, only 10 were intact as assessed by CT. The significance of these findings and application of CT to evaluation of modifications to the Le Fort I osteotomy is discussed.     

Changes in occlusal force after mandibular ramus osteotomy with and without Le Fort I osteotomy

The purpose of this study was to evaluate the differences in bite force changes and occlusal contacts after sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) with and without Le Fort I osteotomy. Sixty female patients with diagnosed mandibular prognathism with or without asymmetry were divided into four groups (SSRO, IVRO, SSRO with Le Fort I osteotomy and IVRO with Le Fort I osteotomy). Bite force and occlusal contacts were measured preoperatively and at 1, 3, 6 and 12 months after surgery with pressure-sensitive sheets. The differences among surgical procedures were examined statistically. Maximum bite force and occlusal contacts returned to preoperative levels after between 3 and 6 months. Regarding time-dependent changes in bite force and occlusal contact area, there were no significant differences among the groups. In conclusion, this study suggests that the combination of IVRO or SSRO and Le Fort I osteotomy does not affect postoperative time-dependent changes.     

The evaluation of surgical factors related to recovery period of upper lip hypoaesthesia after Le Fort I osteotomy.

PURPOSE: It is unclear whether surgical factors can affect the upper lip sensitivity. The aim of this study was to assess the factors that can affect the recovery period of hypoaesthesia of the upper lip after Le Fort I osteotomy, using trigeminal somatosensory evoked potential (TSEP) objectively. PATIENTS AND METHODS: Twenty-nine patients with mandibular prognathism underwent Le Fort I osteotomy with and without artificial pterygoid plate fracture. Trigeminal nerve hypoaesthesia at the region of the upper lip was assessed bilaterally by the TSEP method. The distance between the infraorbital foramen and the osteotomy line (IO) or the nearest plate/screw position (IP) was measured on three-dimensional computed tomography (CT). The relationship between the recovery period in upper lip hypoaesthesia and surgical factors (these distances, movement amount, pterygoid plate fracture) were analysed statistically. RESULTS: The recovery period in upper lip hypoaesthesia did not significantly correlate with IO, IP and movement amount. There was no significant difference between pterygoid plate fracture group and non-fracture group. CONCLUSION: Temporary hypoaesthesia of upper lip after Le Fort I osteotomy could not be avoided, however, osteotomy line, plate/screw position and pterygoid plate fracture in Le Fort I osteotomy did not affect the recovery period of upper lip hypoaesthesia with TSEP.     

Maxillary stability following Le Fort I osteotomy in combination with sagittal split ramus osteotomy and intraoral vertical ramus osteotomy: a comparative study between titanium miniplate and poly-L-lactic acid plate.

PURPOSE: The purpose of this study was to compare changes in maxillary stability after Le Fort I osteotomy with titanium miniplate and poly-L-lactic acid (PLLA) plate (Fixsorb-MX; Takiron Co, Osaka, Japan). PATIENTS AND METHODS: The subjects were composed of 47 Japanese patients with diagnosed jaw deformity: 24 underwent Le Fort I osteotomy and sagittal split ramus osteotomy (SSRO); and 23 underwent Le Fort I osteotomy intraoral vertical ramus osteotomy without internal fixation. Each group was divided into titanium plate and PLLA plate groups. Time course changes between plate groups were compared using lateral and posteroanterior cephalography. RESULTS: Significant differences were identified between titanium plate and PLLA plate groups in A point after Le Fort I osteotomy and SSRO (P < .05). Significant differences existed between titanium plate and PLLA plate groups in vertical component of posterior nasal spine after Le Fort I osteotomy in both combinations with SSRO and intraoral vertical ramus osteotomy (P < .05). However, no significant differences were identified in measurements on posteroanterior cephalography. CONCLUSION: These results suggest a slight tendency for vertical impaction after Le Fort I osteotomy both in combination with SSRO and intraoral vertical ramus osteotomy with PLLA plates, although differences in time course changes were not clinically apparent, and normal occlusion was established in all patients.     

Incidence of maxillary sinusitis following Le Fort I maxillary osteotomy

Twenty adult patients with maxillofacial discrepancies most amenable to correction by Le Fort I osteotomy were evaluated for the incidence of postoperative maxillary sinusitis. Before surgery, each patient was evaluated both radiographically, by Waters' projection technique, and subjectively, according to a brief questionnaire pertaining to sinus symptoms. Identical evaluations were carried out at three- and six-month intervals following surgery. The results show no increase in the incidence of maxillary sinusitis following Le Fort I osteotomy.