上颌骨Le FortⅠ型截骨术常见并发症及其可能原因

ＬｅＦｏｒｔⅠ型截骨术是按ＬｅＦｏｒｔⅠ型骨折线截骨,使上颌骨折断下降,整体移动上颌骨,矫正其各方向的畸形,同时也可于上颌骨的鼻侧面将其分割成若干块,改变上颌牙弓的宽度及平面的弧度,以矫正上下牙弓的不调。各种结果均证明,该手术是安全可靠的。但由于种种原因,常发生一些并发症,甚至严重并发症。本文综述了ＬｅＦｏｒｔⅠ截骨降下术常见的并发症,并对其可能的原因进行了讨论,为临床上防止其发生提供一点参考。１－对牙髓血供的影响：上颌骨及牙髓的血供主要来自颌内动脉及其分支,截骨后必定产生影响。Ｂｅｌｌ［３］的…     

LeFort I 型截骨术在陈旧性上颌骨骨折中的临床应用

目的：探讨LeFortⅠ型截骨术在陈旧性上颌骨骨折中的临床应用。方法：对30例陈旧性上颌骨骨折患者采用LeFortⅠ型截骨术进行治疗，考察其咬合关系等恢复情况。结果：28例患者咬合关系及咀嚼功能恢复满意；2例患者咀嚼功能恢复不理想，考虑为咬合平面的改建没有达到神经-肌肉的平衡。结论：LeFonⅠ型截骨术是治疗陈旧性上颌骨骨折一种较好的方法。     

105例上颌骨截除术的失误与并发症

上颌骨截除术中由于局部解剖结构较复杂,手术过程中容易产生意外损伤和术后的并发症。本文就我院7年来(1983～1989年不完全统计)105例一侧上颌骨全截除和部分截除中的失误和术后并发症作一分析,并对它的原因、预防和处理进行讨论。     

下颌骨截骨术常见的并发症及防治

近年来,随着颌面部肿瘤外科的发展,各种植骨材料的临床应用越来越多。据我院1983——1989年的不完全统计,96例下颌骨截骨植骨中,出现各种并发症共计21例,占21.8％。为减少这些并发症的出现,提高治疗效果。现我们对截骨情况,术后并发症及防治经验小结如下,以供参考。     

LeFortⅠ型截骨术250例的体会

由于颌骨发育畸形或外伤等原因所致面中13颌骨后缩,常伴反异常,不仅影响外貌还可引起咀嚼、言语、颞颌关节紊乱等功能障碍和严重的心理负担,应及时治疗[1～3]。我科自1979年12月至1997年12月共完成LeFort型截骨250例治疗面中13颌骨畸形,获得较好疗效。1　临床资料及手术...     

上颌骨LeFort Ⅰ型截骨前移术对腭咽闭合功能的影响

目的:探讨上颌骨LeFort Ⅰ型截骨前移术对腭咽闭合功能的影响.方法:应用该术矫治18例上颌骨发育不足患者,术前后分别拍摄正中(牙合)位及发[i]位头颅侧位定位片,通过头影测量分析腭咽部组织的变化;同时采用吹气试验及语音清晰度测听比较术前后腭咽闭合功能的变化.结果:上颌骨平均前移6.53±0.76 mm.结论:上颌骨LeFort Ⅰ型截骨前移对患者腭咽闭合功能有一定的潜在不良影响,但术前腭咽闭合功能良好者前移在一定距离范围内不会引起患者腭咽闭合不全,术后腭咽部软组织具有一定的适应性变化;术前腭咽闭合不全者,手术可加重腭咽闭合不全程度.     

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。     

骨支持式3D打印导板在上颌骨LeFortⅠ型截骨术中的应用

目的 探讨3D打印技术制作的截骨导板和再定位导板在上颌骨LeFortⅠ型截骨术中的应用效果。方法 选择8例因上颌发育不良行LeFortⅠ型截骨术的的患者为研究对象,所有患者均进行锥形束CT（CBCT）扫描并建立上颌骨三维模型,使用3D打印技术制作上颌骨截骨导板和再定位导板。所有手术均由同一名医生操作,术中使用截骨导板截骨和再定位导板固定上颌骨块。术后复查CBCT,测量6个标志点到3个基准平面的距离,比较术前虚拟手术与实际手术中上颌骨的位移误差,评估其用于正颌术中上颌骨截骨和再固定的准确性。结果 术后所有患者口内切口均Ⅰ期愈合,无明显并发症。位移误差均值最大为1.35 mm,是左上磨牙点到冠状平面的位移误差;标准差最大为0.85,标准误最大为0.30。位移误差均为临床所接受范围。结论 3D打印技术制作的截骨导板和再定位导板有助于安全、准确地完成上颌骨LeFortⅠ截骨术。     

Modification of LeFort I osteotomy for severe maxillary vertical excess asymmetry

A superfluous maxillary alveolus exacerbates excess of the vertical maxilla, and leads to a severe form of deformity. This poses a unique surgical challenge. In such conditions, the dimensions of the maxilla cephalad to the anterior nasal spine are normal, which limits superior repositioning of the maxilla when done in a conventional manner. The objective of this paper is to highlight the importance of a modified approach to this deformity using a subnasal maxillary osteotomy. Advantages of subspinal maxillary osteotomy include the reduction of maxillary alveolar excess and increase in the scope for maxillary impaction.     

The skeletal and dentoalveolar stability of the maxilla after LeFort I osteotomy for cant correction

Objectives: The aim of this study was to assess the stability of the maxilla after LeFort I osteotomy for correction of maxillary canting caused by skeletal or dentoalveolar disorders.

Methods: The patients underwent conventional LeFort I osteotomy for correction of maxillary canting. Frontal cephalograms were obtained before surgery (T1), immediately after surgery (T2) and more than 1 year after surgery (T3). The angles between the line connecting bilateral latero-orbitales (Lo-Lo^′) and zygoma planes (ZPs) or occlusal planes (OPs) were measured, and the distances from the Lo-Lo^′ or ZP to the left and right upper first molars were also measured to assess skeletal or dentoalveolar disorders at three time points (T1-T3).

Results: In cases in which the Lo-ZP was more than 2^° before surgery (T1), the Lo-ZP changed from 2.28^° (T1) to 1.57^° (T2) or 1.50^° (T3). In cases in which the Lo-ZP changed less than two degrees and the Lo-OP changed more than 2^°, the Lo-OP changed from 2.69^° (T1) to 1.41^° (T2) or 1.08^° (T3), and these changes were significant. Lo-ZP was nearly stable across the time points. The distances from the Lo-Lo^′ or ZP to left and right upper first molars were nearly stable from T2 to T3.

Conclusion: Skeletal and dentoalveolar stabilities were obtained regardless of whether the canting was caused by skeletal or dentoalveolar disorder.     

Fracture of the clivus as an unusual complication of LeFort I osteotomy: case report

LeFort I osteotomy is a standard technique for the surgical correction of dentofacial deformities. Despite its low morbidity, it can lead to various complications at the base of the skull. We report the case of a fractured clivus as an unusual complication.     

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.     

改良LeFort工骨切开和正畸前方牵引矫正骨性上颌后缩一例报告

目的　探讨外科手术和正畸前方牵引治疗骨性上颌后缩的可行性。方法　一例 16岁女性骨性上颌后缩患者 ,前牙反。经术前正畸后 ,先行改良LeFortⅠ骨切开术 颏成形术 ,但不前移上颌骨 ,而是通过面具进行前方牵引。结果　骨性上颌后缩得到明显改善 ,反解除 ,SNA由 77.35°矫治到80 .2 5°。结论　改良LeFortⅠ骨切开术结合正畸前方牵引是治疗生长发育停止后骨性上颌后缩的的一个有效手段。     

Biomechanical evaluation of two miniplate fixations applied in the anterior region after Le Fort I osteotomy: an experimental study

The aim of this experimental study was to evaluate the reliability of two-plate fixations applied to the anterior region of the maxilla after Le Fort I osteotomy in terms of stability. Twenty polyurethane-based skull models were used to evaluate two fixation techniques. Two groups consisting of four and two L-shaped titanium miniplates were tested. Each group was tested with the application of vertical forces in the anteroposterior direction using a servohydraulic testing unit. The displacement values in each group at each stage (from 10 N - 120 N) were compared using the Mann-Whitney U test. The displacement values for the two groups were not statistically significant up to 20 N, but differed significantly between 20 N and 120 N (p < 0.05). The results showed that the biomechanical behaviour of fixation with four miniplates was better than that of two after a load of 20 N. It can be concluded that when the amount of maxillary advancement is increased to 10 mm or more, fixation with only two plates does not provide sufficient stability experimentally.     

Prosthodontic Rehabilitation Using Surgical Space Modification

Treatment using a LeFort I osteotomy and sequential prosthodontic rehabilitation is presented. This treatment combination is a viable alternative therapy for the severe extrusion of posterior maxillary dento-osseous segments.     

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。     

Cranial nerve injuries in Le Fort I osteotomy: a systematic review

The aim of this systematic review was to describe the anatomical and surgical factors related to cranial nerve injuries in Le Fort I osteotomy. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Two independent reviewers performed an unrestricted electronic database search in the MEDLINE/PubMed, LILACS, Scopus, Web of Science, and Cochrane databases up to and including August 2018. Thirty-two articles were selected for data extraction and synthesis: 30 studies were identified in the main search and two by a manual search. The level of agreement between the reviewers was considered excellent (κ = 0.779 for study selection and κ = 0.767 for study eligibility). This study revealed that the main nerve affected was the trigeminal nerve, followed by the oculomotor, abducens, optic, facial, and vagus and accessory nerves. Cleft lip and palate patients presented the highest incidence of cranial nerve damage. Cranial nerve damage after Le Fort I osteotomy is not rare. Anatomical and structural knowledge of the patient are necessary in order to minimize the risks of cranial nerve injury in Le Fort I osteotomy.