正畸联合口外牵引成骨技术治疗骨性上颌后缩

目的 :探讨正畸联合口外牵引成骨技术治疗骨性上颌后缩的可行性。方法 :6例 15～ 2 1岁骨性上颌后缩 ,前牙反牙合患者 ,经术前正畸后 ,行改良LeFortⅠ骨截开术 ,通过弹性和 /或坚强牵引水平向前移上颌骨。结果 :6例患者上颌骨前移 5～ 11mm ,反牙合解除 ,面型改善。牵引过程中有额颏部位压痛、颞下颌关节疼痛等症状。结论 :正畸和口外牵引成骨技术是治疗生长发育后期或停止后骨性上颌后缩的一个有效手段。     

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.     

正颌外科与颌骨牵引成骨

<正> 1 正颌外科简要历史回顾自从1848年美国学者 Hullihen 完成了人类历史上第一例牙颌面畸形矫治以来,正颌外科的发展已经经历了超过一个半世纪的岁月。但是在正颌外科发展初期的100年间,仅有零星的有关牙颌面畸形矫治的报告散在于医学文献中。而且重复着偶尔的成功与大量的失败。20世纪50～70年代,随着人类社会的进步,牙     

上颌骨Le Fort Ⅰ型截骨术后上颌窦炎的研究现状

上颌窦炎是Le Fort Ⅰ型截骨术后常见的并发症,对正颌术后的骨质愈合等非常不利。明确Le Fort Ⅰ型截骨术后上颌窦炎发生的相关因素,针对性采取预防措施,早期发现与及时治疗,对于降低上颌窦炎的发生率,加快患者术后康复,以及提升患者术后生活质量具有重要意义。本文就上颌骨Le Fort Ⅰ型截骨术后并发上颌窦炎的影响、病因、诊断、治疗和预防等进行总结,为正颌外科相关医护人员早期诊治上颌窦炎提供参考。     

牵引成骨术联合正畸治疗重度小颌畸形1例

目的探讨应用下颌骨牵引成骨术联合正畸治疗重度小颌畸形患者下颌骨严重发育不足及咬合关系紊乱的疗效。方法对1例继发于颞下颌关节强直的重度小颌畸形的成人患者,经多学科会诊,确定采用自体肋软骨移植重建右侧下颌髁突,同期行双侧下颌骨牵引成骨术,并联合术后正畸治疗。结果患者经外科和正畸联合治疗后,面形及咬合功能均获得较满意的效果。结论下颌骨牵引成骨术联合正畸治疗成人重度小颌畸形可以获得较为满意的效果。     

正颌外科与颌骨牵引成骨

正颌外科简要历史回顾 自从1848年Hullihen完成了人类历史上第一例牙颌面畸形矫治以来,正颌外科的发展已经经历了超过一个半世纪的岁月.但是在正颌外科发展初期的一百年间,仅有零星的有关牙颌面畸形矫治的报告散在于医学文献中,而且重复着偶尔的成功与大量的失败.     

改良鼻旁植骨减少Le Fort Ⅰ型截骨术后上颌骨垂直向复发的探讨

目的 ：探讨改良鼻旁植骨是否能减少Le Fort 1型截骨下降手术术后上颌骨垂直向的复发。方法 ：选择双颌手术中上颌骨下降幅度>3 mm的患者30例,分为改良鼻旁植骨组和非改良鼻旁植骨组。利用术前(T0)、术后3天(T1)和术后6个月(T2)的颌面CT数据对上颌骨位置进行三维测量;同时利用T1与T2的CT数据计算植骨块厚度的变化。采用SPSS 22.0软件包对数据进行统计学分析。结果：术后6个月,在垂直方向上,改良鼻旁植骨组上切牙点复发量为（0.54±0.35）mm,非改良鼻旁植骨组上切牙点复发量为（1.18±0.76）mm(P=0.3997)。2组在前后、水平方向的复发率无显著差异。改良鼻旁植骨组的植骨块厚度降低（11.75±6.25）%,非改良鼻旁植骨组的植骨块厚度降低（33.77±11.56）%(P<0.0001)。结果：改良鼻旁植骨可有效减少植骨块吸收,以及术后上颌骨垂直向复发。     

两种外置式牵引治疗严重上颌发育不全

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。     

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。     

阻塞性睡眠呼吸暂停低通气综合征的正颌外科及牵引成骨治疗

睡眠呼吸障碍疾病(sleep-related breathing disorders,SRBD)是一类常见、多发疾病,其主要临床表现为：睡眠打鼾、憋气、晨起头痛和疲乏、白日嗜睡、记忆力减退、注意力难以集中以及性功能障碍等。睡眠呼吸障碍多由上呼吸道狭窄、阻塞所致,频繁出现的睡眠低氧是其病理生理基础,不及时治疗将造成严重的后果。阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,     

Midface correction in patients with Crouzon syndrome is Le Fort III distraction osteogenesis with a rigid external distraction device the gold standard?

Introduction

Le Fort III distraction osteogenesis with a rigid external distraction device is a powerful procedure to correct both exorbitism and impaired airways in faciocraniosynostosis. The aim of this study was to investigate treatment effect, perioperative parameters and volumetric outcomes after Le Fort III distraction osteogenesis in patients with Crouzon syndrome in a retrospective study design and to explore potential strengths and weaknesses of this procedure.

Modified Le Fort III osteotomy: A simple solution to severe midfacial hypoplasia

Purpose

There are multiple conditions that may affect the development of the middle third of the face and with varying degrees of severity. The surgical treatment alternatives for major midfacial sagittal deficiencies consist in Le Fort I, II, or III with conventional osteotomies or with distraction osteogenesis (DO). Both techniques have advantages and disadvantages that should be evaluated specifically in each case. The aim of this report is to present a group of patients with severe hypoplasia of the middle third of the face, with different origins, and their treatment with a Modified Le Fort III osteotomy and distraction osteogenesis, using a minimally invasive surgical approach.

Zygomatic repositioning and Le Fort II distraction with intraoral devices in Apert syndrome: A case report

The aim of this case report is to describe the surgical technique and outcome using internal intraoral distraction devices in LeFort II distraction with zygomatic repositioning (LF2ZR).In Apert syndrome the midface is characterized by a complex hypoplasia, with the central part being more affected than the lateral orbito-zygomatic complex. In LF2ZR, the zygomas are repositioned and internally fixated, and the central midface is further advanced through a LeFort II distraction. In previous publications, the distraction has been performed using external halo-based devices.It seems that the LF2ZR procedure can be planned and performed with adequate accuracy using virtual surgical planning tools. Knowledge about the possibility of using internal intraoral distraction devices in LF2ZR is important, as the inconspicuous placement of intraoral devices can be advantageous for some patients.     

Virtual planning in Le Fort III distraction osteogenesis: A case series

The objective of this study is to determine the value of using 3D planning tools and 3D printed cutting guides in Le Fort III osteotomies with external frame distraction osteogenesis.The process of planning and transfer of the virtual planning to the operating room is illustrated with 5 case. The virtual planning is transferred to the operating room using a 3D-printed supra-orbital reference bar with puzzle connections for the planned osteotomy guides. Different systems are presented to transfer the vector of distraction and the position of the external midface distractor.Three-dimensional planning tools and cutting guides help to design the Le Fort III osteotomy and the distraction vector, to anticipate possible difficulties, and to avoid adverse events.     

Evaluation of Post-operative Complication Rate of Le Fort I Osteotomy: A Retrospective and Prospective Study

Le Fort I osteotomy has become a routine procedure in elective orthognathic surgery. This procedure is often associated with significant but rare post-operative complications. The study was conducted to evaluate the rate of post-operative complications following conventional Le Fort I osteotomy. Twenty-five healthy adult patients who had to undergo Le Fort I osteotomy without segmentalization of maxilla were included in the study based on indications of surgery. All the patients were followed up for a period of 6 months post-operatively to assess the rate of various post-operative complications such as neurosensory deficit, pulpal sensibility, maxillary sinusitis, vascular complications, aseptic necrosis, unfavourable fractures, ophthalmic complications and instability or non-union of maxilla, etc. The results of our study showed a post-operative complications rate of 4 %. Neurosensory deficit and loss of tooth sensibility were the most common findings during patient evaluation at varying follow-up periods while one patient presented with signs and symptoms of maxillary sinusitis post-operatively. Neurosensory as well as sinusitis recovery took place in almost all the patients within 6 months. It was concluded that thorough understanding of pathophysiological aspects of various complications, careful assessment, treatment planning and the use of proper surgical technique as well as instrumentation may help in further reducing the complication rate.     

Additional orthognathic surgery following Le Fort III and monobloc advancement

Severe midface hypoplasia in patients with various craniofacial anomalies can be corrected with Le Fort III or monobloc advancement. Often additional corrective orthognathic surgery is indicated to achieve Class I occlusion and a normal inter-jaw relationship. This study evaluated the incidence of, and the surgical indications for, secondary orthognathic surgery following Le Fort III/monobloc advancement. The total study group consisted of 41 patients: 36 patients with Le Fort III advancement and 5 patients with monobloc advancement. Seven patients underwent additional orthognathic surgery. Of the resulting 18 non-operated patients older than 18 years at the end of follow-up, Class I occlusion was observed in 11 patients. In the remaining patients malocclusions were dentally compensated with orthodontic treatment. None of the patients was scheduled for additional orthognathic surgery due to the absence of functional complaints and/or resistance to additional surgery. Le Fort III and monobloc advancement aim to correct skeletal deformities on the level of zygoma, orbits, nasal area and forehead, but Class I occlusion is frequently not achieved. Additional orthognathic surgery is often indicated in patients undergoing Le Fort III or monobloc advancement. Naso-endoscopic analysis of the upper airway and the outcomes of sleep studies may influence the orthognathic treatment plan.     

Higher need for removal of osteosynthesis material after multi-piece versus one-piece Le Fort I osteotomy: A retrospective study of 339 patients

The aim of the present study was to identify the risk factors for removal of osteosynthesis material after multi-piece Le Fort I osteotomy compared to standard one-piece Le Fort I osteotomy (LF1).Medical files of patients treated with multi-piece or one-piece LF1 were retrospectively reviewed, including the indication for removal and time between insertion and removal. A total of 339 patients were included: 290 patients with LF1 and 49 patients with multi-piece LF1.Patients undergoing multi-piece LF1 had 2.7-times significantly higher (p < 0.001) relative risk of osteosynthesis removal in the upper jaw (42.9%) than patients undergoing LF1 (15.9%). Significant independent predictors of removal of osteosynthesis material after multi-piece LF1 were older age (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.0–1.2; p = 0.028), simultaneous bilateral sagittal split osteotomy (OR 7.8, 95% CI 1.2–50.3; p = 0.031), and no previous surgically assisted rapid palatal expansion (OR 0.14, 95% CI 0.03–0.69; p = 0.15).Significantly higher removal rates of osteosynthesis material were found after multi-piece LF1. Therefore, all patients must be informed of the higher risk for removal of osteosynthesis material when undergoing a multi-piece LF1.     

Surgical complications of segmental Le Fort I osteotomy

Segmental maxillary osteotomy is a useful adjunct in orthognathic surgery for the correction of vertical and transverse maxillary deformities, but we know of few published reports that document complications. We evaluated the complication rates associated with segmental maxillary surgery in our unit by retrospective review of medical records, radiographs, and study models of 85 consecutive patients (mean age 23.3 years, range 14–51; male:female ratio 1:2) treated from 1995 to 2009. Types of deformity were anterior open bite (n = 30, 35%), transverse maxillary deficiency (n = 24, 28%), anterior open bite with transverse maxillary deficiency (n = 28, 33%), and anterior vertical maxillary excess (n = 3, 4%). There were 70 tripartite (82%), 13 bipartite (15%), and two quadripartite (2%) maxillas. Twenty-one patients (25%) had bone grafts. Fixation was done using titanium miniplates in 80 patients (94%), and titanium miniplates and resorbable plates in five (6%). The overall complication rate was 27%. Three patients (4%) had devitalisation of teeth, three (4%) developed minor periodontal defects, and one had tooth loss. Eight patients (9%) had plates removed, and two patients developed persistent postoperative palatal fistula. There was no segmental loss of bone or teeth. Our results show that complications in this cohort were relatively low, and that segmental maxillary surgery is safe as an adjunct in carefully selected cases.