双颌手术同期植骨矫治唇腭裂术后严重双颌畸形  

Simultaneous bimaxillary orthognathic surgery and bone grafting for correction of secondary severe bimaxillary deformities in cleft patients

作　　者：任敏[1] 滕利[2] 孙晓梅[2] 归来[2] 

机构地区：[1]安徽医科大学第一附属医院乳腺外科,安徽合肥230022 [2]中国医学科学院中国协和医科大学整形外科医院,北京100041

出　　处：《中国美容医学》2009年第2期169-172,共4页Chinese Journal of Aesthetic Medicine

摘　　要：目的:总结分析高位LeFortI型截骨术与下颌升支矢状劈开截骨术联合应用,配合牙槽嵴裂植骨术矫治唇腭裂术后严重双颌畸形的手术设计与效果。方法:2002年1月～2006年4月,共收治18例唇腭裂术后严重双颌畸形患者,男8例,女10例。年龄16～33岁,平均24.5岁。单侧唇腭裂15例,双侧3例。影像学检查均有继发严重双颌畸形的主要表现。均联合应用高位LeFortI型截骨术和下颌升支矢状劈开截骨术,同期行牙槽嵴裂自体髂骨游离移植Ⅰ期手术矫正。结果:术后伤口均I期愈合。复查头部X线片,所有患者上、下颌骨位置均得到明显改善。随访6个月～3年,牙弓外形良好,X线片示无明显骨质吸收,植骨区密度与周围接近。18例均获得满意面容及良好的关系。结论:高位LeFortI型截骨术与下颌升支矢状劈开截骨术联合应用,配合牙槽嵴裂植骨术可以Ⅰ期矫治唇腭裂术后严重双颌畸形,并可以获得满意的手术效果。不但可以减少手术次数,而且还降低了手术费用,是矫治唇腭裂术后严重双颌畸形的一种有效方法。Objective To Summarize our experience ramus osteotomy combining with bone grafting in the n simultaneous high level Le Fort same operation for correction of Ⅰ osteotomy and sagittal split secondary severe bimaxillary deformities in cleft patients. Methods From January 2002 to April 2006, 18 cleft patients suffering from secondary severe bimaxiilary deformities were treated. There were 8 males and 10 females, aged from 16 to 33 years （mean age： 24.5 years）. 15 patients were unilateral cleft and 3 were bilateral cleft. All patients were operated by high level Le Fort Ⅰ osteotomy and sagittal split ramus osteotomy combining with bone grafting in the same operation for deformities correction. Results All 18 patients were satisfied with their appearances and dental articulation after operation. With an X-ray re-examination,maxillary and mandibular bone were returned to their normal position in all patients. After a follow up of 6 months to 3 years,dental arch had good appearance. The X-ray films showed no obvious bone absorption. The density of grafting bone was approximation to the normal bone. Conclusions High level Le Fort Ⅰ osteotomy and sagittal split ramus osteotomy combining with bone grafting in the same operation can receive satisfied results for correction of secondary severe bimaxillary deformities in cleft patients. It can not only decrease the frequency of operation, but also save the treatment expense. So it is an effective method for correction of the secondary mid-face deformities in cleft patients.

关 键 词：高位Le FORT Ⅰ型截骨术 下颌升支矢状劈开截骨术 植骨 双颌畸形 唇腭裂 

分 类 号：R782.2[医药卫生—口腔医学] R783.9[医药卫生—临床医学]