严重复杂性颅颌面骨折后继发畸形的修复重建

目的 探讨严重复杂性颅颌面骨折后,继发畸形晚期重建的手术步骤及手术方法.方法 采用头皮冠状切口、下睑睫毛缘切口及口内龈颊沟切口入路,充分显露所有骨折部位.按照先上后下、再中间,由外向内的顺序进行各功能区域的修复.首先经颅内外联合入路修复额眶部畸形,然后进行眶颧部外侧面部支架的截骨重建,再行下颌骨截骨复位,最后行上颌骨Le Fort Ⅰ型截骨,颌间结扎后,通过下颌骨确定上颌骨的位置并用小夹板内固定.应用自体骨重建鼻背骨性支架,重塑鼻背轮廓;内眦韧带复位固定和内眦整形矫正创伤性内眦距增宽,恢复鼻根部高度与内眦间距的协调比例关系;同时眶壁植骨修复,缩小扩大的眶腔,矫正眼球内陷畸形.结果 共治疗复杂性颅颌面骨折后继发畸形12例.所有患者畸形均获明显改善,咬牙合功能恢复良好.结论 复杂性颅颌面骨折多涉及颅面骨三个或三个以上区域,骨折变化多样.熟知各区域的解剖功能特点、合理设计手术方案,方可最大程度地改善外形,恢复功能.

The secondary reconstruction of complex post cranio-maxillo-facial fracture deformities

Objective To study the operative steps and methods in the reconstruction of complex post cranlo- maxillo - facial fracture deformities. Methods The bicoronal and subcillary incisions and intro - oral approach were employed to expose all the fractured sites. The fronto - orbital deformity was reconstructed firstly through intro- extro cranial approach, then the displaced orbito- zygomatic bone fragments were repositioned in order to reconstruct the outer midfacial framework. The fractured or malunited mandible was reconstructed before the reduction of the maxilla, after that, the malunited maxilla was reduced to its proper position after Le Fort I osteotomy by the guide of mandible through intermaxilla fixation. The depressed naso - orbital region were reconstructed using autogeneous outer cranial table, including nasal framework reconstruction, fractured orbital walls repairing, medial canthal tendon reapproximation by transnasal wire fixation. Results Tweleve cases of complex post cranio- maxillo- facial fracture deformities were reconstructed with the mentioned technique above. All the patients recovered well and the post - operative facial appearance and occlusal function were improved greatly. Conclusion Complex post cranio - maxillo - facial fracture deformities often involve more than three functional regions of the cranio - facial framework, the facial appearance and occlusal function can be greatly improved by the understanding of the anatomical characteristics of the different functional parts and reasonable operative plan.