面中部牵引成骨结合正颌手术治疗Binder综合征

目的：Binder综合征患者有严重的面部凹陷畸形及咬合功能障碍,治疗相对困难且易复发。本研究探讨面中部牵引结合正颌手术在Binder综合征治疗中的价值。方法：4例Binder综合征患者采用改良Le Fort II型截骨术,术后利用颅骨外置式牵引器进行旋转牵引,并随时调整矢状向及垂直向的量,矫正患者面形。半年后进行正颌手术,矫正咬合关系,并随访1~2 a。结果：4例患者均顺利完成整个治疗过程,无明显并发症发生。牵引过程中无明显疼痛及不适。头影测量显示,患者面中部骨骼显著前移,凹陷畸形得以矫治。经过正颌-正畸联合治疗,获得了良好的咬合关系。结论：上颌骨Le Fort II型截骨牵引可以矫治鼻上颌骨发育不足,通过正颌手术可以矫正咬合关系,两者结合是一种较为理想的治疗Binder综合征的方法。

Le Fort II midfacial distraction combined with orthognathic surgery in the treatment of Binder syndrome

PURPOSE： Patients with Binder syndrome have severe facial concavity and compromised skeletal Class III malocclusion. Its treatment is still challenging the surgeons. The aim of this study was to evaluate the effect of combined midfacial distraction and orthognathic surgery in the treatment of Binder syndrome. METHODS： Four patients with Binder syndrome were enrolled in this study. After modified Le Fort II osteotomy, the rotational distraction of nasomaxillary complex was performed to rehabilitate facial convexity. Then bilateral sagittal split ramus osteotomy（BSSRO）with or without Le Fort I osteotomy were used to correct malocclusion. RESULTS： All patients healed uneventfully and the maxillae moved forward conspicuously. No obvious pain and severe discomfort was complained during distraction. A significant advancement and downward movement of the maxilla was shown by cephalometric analysis. CONCLUSIONS：The combination of midfacial distraction and orthognathic surgery provided us an ideal alternative in the treatment of nasomaxillary hypoplasia.