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.

Application of orthognathic surgery in treating long-standing maxillofacial fracture

PURPOSE: To explore the application of orthognathic surgery to treat malunioned fracture of maxillofacial bone, and the methods in reconstructing facial shape and occlusion. METHODS: 20 patients with maxillofacial malunioned fracture were involved in this study, the site of osteotomy and plan of operation were determined preoperatively with three-dimensional CT reconstruction, cephalometric analysis and model surgery. Occlusal guide plate was made in cases with malocclusion. Then osteotomies were performed in planned sites. Rigid internal fixation was conducted after restoring occlusion and facial contour. RESULTS: All patients were recovered to normal facial contour after operation, and the occlusion was satisfactory. Four cases with maxillary osteotomy developed bone unhealing in the lateral wall of the maxilla, with oral antral fistula in 2 patients. CONCLUSIONS: With orthognathic surgery and rigid internal fixation, it is easy to reduce long-standing maxillofacial fracture and recover normal occlusion.