唇腭裂继发上颌骨发育不足牵引成骨后颌骨变化

目的　比较唇腭裂术后继发上颌骨发育不足患者颅外支架式牵引成骨术 (RigidExternalDistraction ,RED)前后上下颌骨前后向和垂直向位置及牙颌关系变化 ,评价RED治疗上颌发育不足效果。方法　唇腭裂术后继发上颌骨发育不足患者 2 2名 ,其中男性 1 4名 ,女性 8名 ,平均年龄为 1 5 3岁。所有患者在改良高位LeFortⅠ型截骨术基础上行颅外支架式上颌骨牵引成骨术。测量RED前后头颅定位侧位片上下颌骨位置及牙颌关系各项指标 ,用配对t检验比较RED术前术后变化。　结果　RED前后SNA角、NA与FH夹角、Ptm至S距离、Ptm至A距离、上中切牙至腭平面距离、上颌第一磨牙至腭平面距离、SNB角、面角、颌凸角、下颌平面角、ANB角、Y轴角、NA与AMe比、覆牙合和覆盖变化具高度显著性差异。　结论　RED用于唇腭裂术后继发上颌骨发育不足患者 ,可有效地延长上颌骨长度和高度并使之前移 ;下颌骨则顺时针旋转 ,上下颌骨间位置和比例更为协调 ,下颌骨的生长发育方向更趋于正常     

前段截骨牵引治疗唇腭裂继发上颌骨发育不足

目的 :利用颅外支架外固定牵引技术,采用上颌骨前段截骨牵引的方式治疗唇腭裂继发上颌骨重度发育不足患者,探讨手术效果并进行术后稳定性的评价。方法:选取唇腭裂术后继发上颌骨重度发育不足患者15例,采用上颌骨前段截骨,颅外支架外固定式牵引器进行术后牵引,通过头影测量分析,评价其术后效果及长期稳定性。利用SPSS 13.0软件包对数据进行方差分析。结果 :所有患者均顺利完成上颌骨前段截骨及颅外支架的固定,术后进行牵引,无明显并发症发生,面型及咬合关系显著改善,牵引成骨后上颌骨凸度、前牙覆盖、上颌骨长度和高度等显著增加(P<0.05),术后无明显复发(P>0.05)。而腭咽腔的深度、软腭长度无明显改变,语音功能未受明显影响。结论:上颌骨前段截骨配合颅骨外支架牵引能够显著增加上颌骨长度,同时避免了对腭咽闭合功能的损伤,降低了术后复发的风险,是一种理想的矫治唇腭裂继发上颌骨发育不足的方法。     

唇腭裂术后上颌骨发育不良骨牵引矫治的临床研究

目的:探讨口内入路牵引成骨技术在唇腭裂术后继发上颌骨发育不良患者成年之前矫治中的作用。方法:对12例9～12岁唇腭裂术后继发上颌骨明显发育不良者,采用高位LeFortI型截骨术,将上颌骨完全断离,安装口内牵引器,按一定的速度和频率牵引上颌骨向前,对术前、术后头颅定位X线侧位片进行颅颌面软硬组织的测量分析,数据以SPSS10.0统计软件包进行t检验。结果:本组病例上颌骨牵引前移明显,SNA角增加7°～11°,软组织鼻尖点、鼻底点及上唇最突点明显前移,面部外形得到明显改善,上下前牙获得正常覆牙合、覆盖关系。随访3～36个月,咬合关系保持稳定。结论:骨牵引成骨技术可以很好地用于矫治唇腭裂术后继发上颌骨发育不良,早期解除上颌骨畸形,使面部软组织得到适应性改变,面型更为协调,避免或减轻口颌系统继发畸形和功能障碍,不失为唇腭裂术后继发上颌骨发育不良的有效治疗方法。     

唇腭裂患者上颌骨牵引成骨术后发音方式的变化

目的:通过对行颅外支架式上颌骨牵引成骨术(rigidexternaldistraction,RED)唇腭裂患者治疗前后的错误发音数量变化、不同发音部位、不同发音方法以及不同类型错误发音发生特点及其变化评价,分析上颌骨RED对患者发音方式的影响。方法:1999年至2001年行上颌骨RED的唇腭裂术后上颌发育不足患者21例,其中男性13例,女性8例,平均年龄15.05岁。所有患者RED前后进行语音测听并分类。治疗前后错误发音的差异性用非参数检验。结果:RED术后42.9%患者错误发音数较RED前增加,19.0%减少,38.1%无变化。从发音部位,舌尖前音错误发音发生率最高,其次为舌面音。从发音方法,错误发音多发于塞擦音。错误发音类型以咽喉摩擦/爆破音为主,其次为腭化构音和声门爆破音。上颌骨RED后腭化构音累及音节数减少,但咽喉摩擦/爆破音和声门爆破音反而增加,尤其是咽喉摩擦/爆破音。结论:唇腭裂患者经RED前移上颌骨后,会对患者发音方式产生影响,在行语音治疗前需考虑全面。     

唇腭裂患者上颌骨牵引成骨术后口鼻腔共鸣的变化

目的:通过研究行颅外支架式上颌骨牵引成骨术(rigidexternaldistraction,RED)的唇腭裂患者前后过度鼻音、过低鼻音的变化,并结合腭咽部结构功能变化、上颌骨前移幅度等因素,综合分析上颌骨RED对口鼻腔共鸣的影响。方法:1999年至2001年行RED治疗的唇腭裂术后上颌发育不足患者21例,其中男性13例,女性8例,平均年龄15.05岁。所有患者RED手术前后语音测听、拍摄静止位及[i]位头颅定位片测量腭咽闭合功能,对检测结果行非参数检验。结果:RED术后患者过度鼻音程度显著加重。RED前61.9%患者存在过度鼻音,RED术后增至90.5%,所有患者均未出现过低鼻音。上颌骨前移幅度对患者术后过度鼻音加重程度有显著影响。患者腭咽闭合冠状收缩不全率(RVCR)和RED前的过度鼻音程度也直接影响术后的过度鼻音程度。结论:唇腭裂患者经RED前移上颌骨后,鼻腔共鸣增加,过度鼻音加重。     

唇腭裂继发上颌骨发育不足牵引成骨后腭咽部功能变化

目的　通过颅外支架式上颌骨牵引成骨术 (RigidExternalDistraction ,RED)前后唇腭裂患者静止位和[i]发音位头颅定位侧位片腭咽部结构变化 ,拟评价上颌骨牵引成骨术对唇腭裂患者腭咽部结构功能的影响及其相关因素。方法　 1999～ 2 0 0 1年行颅外支架式上颌骨牵引成骨术的唇腭裂术后上颌发育不足患者 2 1名 ,平均年龄15 .0 5岁。所有患者RED术前后拍摄静止位及 [i]位头颅定位片 ,然后对腭咽部结构功能指标测量分析。结果　(1)RED术后PNS A、PNS PPW、NR、ASPHP、RVCR、EASP和MSP具有显著性变化 ;(2 )RVCR的变化与上颌骨前移幅度、PNS PPW增加幅度和NR增大程度呈正相关。上颌前移幅度还与软硬腭夹角增加呈正相关。结论　 (1)上颌骨牵引成骨术后腭咽腔深度增加 ,对唇腭裂患者腭咽闭合功能仍有一定负面影响 ,但同时腭咽部软组织有代偿性改变 ;(2 )上颌骨前移幅度与RED术后腭咽闭合功能变化有关 ;(3)咽后壁瓣的存在对防止和减少RED术后腭咽闭合功能不全产生有积极作用。     

上颌骨牵引成骨术矫治上颌牙弓狭窄

目的 观察上颌骨牵引成骨术矫治上颌牙弓狭窄的疗效。方法 对１０例成年患者行上颌Ｌｅ Ｆｏｒｔ Ｉ型截骨术（不移动骨块）,并手术截开腭中缝骨联结。以上颌快速扩弓装置（６４１４６带环）,每日打开螺旋４次,共１．０ｍｍ。其中２例行单侧扩大牙弓,矫正上颌单侧牙弓宽度不足。利用计算机图形数据分析系统对扩弓前后的后前位头颅定位片进行测量（上颌骨、上颌牙弓基骨、上颌后牙间的宽度）并通过上颌前部咬合片观察腭中缝的     

唇腭裂患者不同截骨方式下上颌骨外置式牵引成骨的比较

目的：利用颅外支架外固定式牵引器治疗唇腭裂继发上颌骨重度发育不足患者,分别采用上颌骨前段截骨和整块截骨方式,探讨不同截骨方式的牵引成骨效果。方法：唇腭裂术后继发上颌骨重度发育不足患者10例,反覆盖均超过10mm。采用传统整块截骨5例,前段分块截骨5例,均利用颅外支架固定式牵引器行术后牵引。通过头影测量分析,比较其矫治效果。利用SPSS13.0软件包对数据进行独立样本t检验。结果：所有患者均成骨良好,无明显并发症,面形及咬合显著改善。牵引成骨后,SNA角、NA与FH夹角、前牙覆盖、零子午线与Sn距离等显著增加。前段截骨组硬腭长度增加7.50mm,2组间有显著差异（P〈0.05）。而软腭长度、静止位腭咽腔深度无显著差异。结论：上颌骨前段截骨牵引在增加硬腭和牙弓长度、避免腭咽腔深度增加及腭咽闭合功能恶化方面具有更大优势,是一种较为理想的矫治唇腭裂术后继发上颌骨发育不足的方法。     

唇腭裂继发上颌骨发育不足患者牵引成骨后软组织侧貌变化

目的　比较唇腭裂术后继发上颌骨发育不足患者颅外支架式牵引成骨术 (RigidExternalDistraction ,RED)前后软组织面型及鼻唇部变化 ,评价RED治疗上颌发育不足效果。方法　唇腭裂术后继发上颌骨发育不足患者 2 2名 ,其中男性 14名 ,女性 8名 ,平均年龄为 15 3岁。所有患者在改良高位LeFortⅠ型截骨术基础上行颅外支架式上颌骨牵引成骨术。测量RED前后头颅定位侧位片软组织面型、鼻唇部结构各项指标 ,用配对t检验比较RED术前术后变化。结果　RED前后面凸角、软组织鼻根点至零子午线距离、软组织颏前点至零子午线距离、上唇长度、唇间隙、唇颏比和颏唇沟深度变化具高度显著性差异。鼻唇角RED后增加了 7°。上中切牙露出程度无变化。结论　RED治疗唇腭裂术后继发上颌骨发育不足患者 ,在有效地延长前移上颌骨同时 ,面中下部软组织得到适应性改变 ,使面型更为协调 ,上唇长度得到延长 ,鼻唇角趋向增大。     

牵引成骨术治疗唇腭裂继发颌骨畸形稳定性的研究进展

牵引成骨术（distraction osteogenesis,DO）在口腔颌面外科的应用越来越广,为唇腭裂继发颌骨畸形治疗提供了新的手段。DO按牵引类型主要分为内置式牵引（intraoral distraction osteogenesis, IDO）和外置式牵引（extraoral distraction osteogenesis, EDO）2种,在大距离前徙上颌骨时,唇腭裂牵引成骨术后的长期稳定性和复发的报道还很少。本文就牵引成骨治疗唇腭裂继发颌骨畸形术后的长期稳定性的临床研究进展作一综述。     

Management of severe cleft maxillary deficiency with distraction osteogenesis: Procedure and results

Distraction osteogenesis has become an important technique to treat craniofacial skeletal dysplasia. In this study, the technique of maxillary distraction with a rigid external distraction device is presented. Cephalometric results in the first 14 consecutive patients are analyzed. The study sample consisted of 14 patients with various cleft types and maxillary hypoplasia treated with the rigid external distraction technique. Analysis of the predistraction and postdistraction cephalometric radiographs revealed significant skeletal maxillary advancement. All patients had correction of the maxillary hypoplasia with positive skeletal convexity and dental overjet after maxillary distraction. The morbidity for the procedure was minimal. Surgical and orthodontic procedures are thoroughly described. (Am J Orthod Dentofacial Orthop 1999;115:1-12)     

Anesthetic concerns of external maxillary distraction osteogenesis

BACKGROUND: External maxillary distractions present additional anesthetic concerns to the existing complexity of the patient with craniofacial disorder. The distraction hardware is rigidly fixed to the cranium and projects in the frontofacial midline, thus limiting oronasal airway access. METHODS: A review of 16 patients (10 male, 6 female) having external maxillary distraction was done. Patients with patent tracheostomies were excluded. In all cases, the same type of external distraction device was used (R.E.D., K.L.S. Martin, Jacksonville, FL, USA). Perioperative records were reviewed for medical history; operative diagnosis, presence of airway disease, tracheostomy, laryngoscopy grade, use of fiberoptic bronchoscope, procedure, operative time, use of intraoperative steroid, day of postoperative extubation, and need for reintubation were documented. RESULTS: The study group was subdivided into two diagnostic categories: those with syndromic craniosynostosis (n = 9) and those with cleft lip/palate (CLP) (n = 7). Patients in the craniosynostotic group had grade 1 laryngoscopy views, with the exception of a single patient with Crouzon syndrome who had a grade 3 view. This was the only patient who required fiberoptic intubation. One patient with Apert syndrome required reintubation (48 hours after surgery); successful extubation was done 96 hours later. In the cleft lip/palate group, all patients had grade 1 laryngoscopic views, except one with a grade 3 view; no patient required fiberoptic intubation. Six of the seven patients were extubated immediately after surgery, with one patient extubated the next day. No patient experienced failure of extubation. CONCLUSIONS: External maxillary distraction minimally affects anesthetic management provided certain safeguards are observed. The vertical bar can be left attached to the cranial portion of the distractor, or it can be removed for extubation or reintubation. Removal of the vertical bar allows unobstructed direct laryngoscopy. This emphasizes the importance for the emergent availability of the appropriate screwdrivers and wire cutters to remove the vertical bar and trained personnel to perform the removal.     

Simultaneous maxillary and mandibular distraction osteogenesis with a semiburied device

Distraction osteogenesis is a technique utilizing natural healing mechanisms to generate new bone; it is commonly used to lengthen the hypoplastic mandible. Distraction of the maxilla and mandible as a unit is an obvious extension of the technique. We describe the application of a semiburied distractor to simultaneously lengthen the mandible and maxilla and level a canted occlusal plane in three cases. The indications for bimaxillary distraction are reviewed, including its advantages, disadvantages and limitations.     

Two-stage maxillary distraction osteogenesis using a modified external device: clinical outcome and complications

Rigid external distraction is currently used to correct severe maxillary hypoplasia. The purpose of this retrospective study was to present the clinical results and complications of a two-stage surgical approach using a modified external distraction system that consists of maxillary distraction and then maxillary fixation. We treated eight patients with cleft lip and palate in this way from 2016 to 2018. Lateral cephalograms taken before the first operation, after distraction, two weeks after the second operation, and one year after treatment were used to examine maxillofacial morphology. Velopharyngeal function was evaluated by a speech therapist. The mean movements of the maxilla forwards and downwards at Point A were 12.0 mm and 8.0 mm at the completion of distraction and those at Point B were 5.0 mm backwards and 9.7 mm downwards. Mouth opening was limited at this time, and was relieved after maxillary fixation. The mean relapse one year postoperatively was 24.3% horizontally and 52.5% vertically. Velopharyngeal function was unchanged by the operation. We conclude that the method has advantages that include the short duration of wearing distractors and increased acceptance by patients. The modified external device advanced the midface sufficiently.     

正畸结合上颌前部牵引成骨矫治严重骨性畸形唇腭裂患者

Objective To treat cleft patient with maxillary deficiency by means of orthodontics and maxillary distraction osteogenesis. Method Maxillary distraction osteogenesis was performed to increase bone mass and orthodontic treatment was carried out after surgery. Results The cleft patient with maxillary deficiency was treated successfully, ANB was increased by 9° and good occlusal relationship was achieved. Conclusions The cleft patient with maxillary deficiency could be treated successfully with maxillary distraction osteogenesis and orthodontics.     

正畸结合上颌前部牵引成骨矫治严重骨性畸形唇腭裂患者

目的 探讨采用正畸结合部分上颌骨牵引成骨的方法,治疗上颌骨严重发育不足的唇腭裂患者.方法 使用正畸结合上颌骨部分牵引成骨的方法,首先进行上颌骨前部牵引成骨,增加上颌骨的骨量,再进行正畸治疗排齐牙齿,最终解决上颌骨发育不足和牙齿拥挤的问题.结果 患者矫治后ANB角增加9°,面型明显改善,(牙合)关系良好.结论 采用正畸结合上颌骨部分牵引成骨这一新技术,矫治上颌骨发育严重不足的唇腭裂患者能够获得良好的治疗效果.

Abstract：

Objective To treat cleft patient with maxillary deficiency by means of orthodontics and maxillary distraction osteogenesis. Method Maxillary distraction osteogenesis was performed to increase bone mass and orthodontic treatment was carried out after surgery. Results The cleft patient with maxillary deficiency was treated successfully, ANB was increased by 9° and good occlusal relationship was achieved. Conclusions The cleft patient with maxillary deficiency could be treated successfully with maxillary distraction osteogenesis and orthodontics.     

Rigid external distraction osteogenesis for a patient with maxillary hypoplasia and oligodontia.

OBJECTIVE: In this report, the orthodontic treatment combined with rigid external distraction osteogenesis in a 5.5-year-old girl with midfacial hypoplasia and oligodontia is described. PATIENT: The child presented with a reduced maxilla, protruding lower lip, skeletal Class III jaw relationship with a low mandibular plane angle, a short and flattened nose, anterior crossbite, and aplasia of 16 permanent teeth. The patient was treated with rigid external maxillary distraction osteogenesis, maxillary protraction headgear, and Class III elastics. Following treatment, the maxilla was displaced in a forward direction with new bone formation at the tuberosities and the mandible rotated backward in relation to the anterior cranial base. The anterior crossbite was corrected, and the skeletal jaw relationship changed from a Class III to a Class I skeletal pattern. The soft tissue facial profile showed that the nasal projection had been increased, the nasolabial angle increased, and the lower lip protrusion was reduced. Postoperative treatment results were acceptable. CONCLUSION: This report documents that early maxillary advancement with rigid external osteogenesis offers a promising treatment alternative for a very young patient with maxillary hypoplasia and oligodontia.     

Velopharyngeal changes after maxillary advancement in cleft patients with distraction osteogenesis using a rigid external distraction device: a 1-year cephalometric follow-up

The effect of maxillary advancement on speech may have benefits on articulation improvement but compromises velopharyngeal (VP) closure by increasing the nasopharyngeal distance. The purpose of this study was to evaluate the static VP anatomic changes on lateral cephalograms in patients who underwent maxillary advancement through distraction osteogenesis (DO) with a rigid external distraction device and to correlate these changes with clinical speech data. Twenty-two patients (5 female and 17 male) underwent maxillary advancement through DO utilizing a rigid external distraction device (age, 5.2 to 25.7 years) with various diagnoses, including 13 unilateral cleft lip and palate (CLP) patients, 5 bilateral CLP patients, 1 isolated cleft palate patient, 2 facial cleft patients, and 1 patient with craniosynostosis. Lateral cephalograms of preoperative, immediate postdistraction, and 1-year postdistraction were obtained for analysis. Speech evaluation was performed preoperatively, immediate postdistraction, and then at 6-month intervals, and included assessment of air pressure flow, hypernasality, and articulation. With an average amount of 8.9 mm maxillary forward advancement, 14% of patients (3 of 21) presented deterioration in hypernasality. However, 57% of patients (12 of 21) demonstrated improvement in articulation. The cephalometric analysis demonstrated an increase in nasopharyngeal depth by 8.5 mm (1:1 ratio with bony movement) and velar angle by 14.1 deg. The length of the soft palate remained unchanged. The need ratio (intersection of palatal plane and posterior pharyngeal wall-posterior nasal spine/posterior nasal spine--tip of uvula) worsens after distraction. The deterioration of hypernasality was related to the amount of forward distraction, especially in patients without a preexisting pharyngeal flap (PF). Speech evaluation is an important aspect concerning treatment planning for maxillary distraction. The increase in nasopharyngeal depth may compromise VP closure. The increase in velar angle was considered to be part of the compensation in the VP mechanism. An adverse effect of a preexisting PF on maxillary distraction was not observed; however, it prevented postoperative hypernasality.