CAJ | 학술논문

目的探讨下颌骨牵引成骨配合正颌手术治疗成人严重半侧颜面短小畸形的方法.方法将患者三维CT重建数据导入Mimics软件进行手术模拟设计,确定截骨线的位置、牵引向量以及拟牵引的长度并制作手术导板.一期手术行口外入路内置式牵引器置入术,术后5～7d开始骨牵引,延长速度为1 mm/d,牵引结束后,牵引器保留3～6个月.二期手术采用上颌骨Le Fort Ⅰ型截骨,将上颌骨旋转、下降,关闭患侧开颌,采用下颌骨外板植入到上颌截骨下降后的间隙并妥善固定,以保证骨质愈合、维持上颌截骨下降后的稳定性、增加患侧上颌骨的骨体积以增加患侧的丰满度.颏部仍遗留偏斜或形态位置不佳者,同时行颏成形术予以调整.结果 2009年9月至2012年3月,采用上述方法矫治9例半侧颜面短小畸形患者,术后面部对称性、咬合关系趋近正常,效果满意.8例未出现任何并发症,1例上颌切口感染,经清创换药后延迟愈合,未影响面部形态及咬合关系.结论下颌骨牵引成骨配合正颌手术是矫治成人半侧颜面短小畸形的有效方法.
목적 탐토하합골견인성골배합정합수술치료성인엄중반측안면단소기형적방법.방법 장환자삼유CT중건수거도입Mimics연건진행수술모의설계,학정절골선적위치、견인향량이급의견인적장도병제작수술도판.일기수술행구외입로내치식견인기치입술,술후5～7d개시골견인,연장속도위1 mm/d,견인결속후,견인기보류3～6개월.이기수술채용상합골Le Fort Ⅰ형절골,장상합골선전、하강,관폐환측개합,채용하합골외판식입도상합절골하강후적간극병타선고정,이보증골질유합、유지상합절골하강후적은정성、증가환측상합골적골체적이증가환측적봉만도.해부잉유류편사혹형태위치불가자,동시행해성형술여이조정.결과 2009년9월지2012년3월,채용상술방법교치9례반측안면단소기형환자,술후면부대칭성、교합관계추근정상,효과만의.8례미출현임하병발증,1례상합절구감염,경청창환약후연지유합,미영향면부형태급교합관계.결론 하합골견인성골배합정합수술시교치성인반측안면단소기형적유효방법.
Objective To study the combination of Mandibular distraction and orthognathic techniques for the reconstruction of adult hemifacial microsomia.Methods The three-dimensional CT reconstruction data was used with Mimics for preoperation design.The osteotomy location,distrction vector,distraction distance were decided before operation with a surgical guider.At the first stage,internal distractor was implanted after ostetomy through an extra-oral approach.The distraction begun 5-7 days after operation with a frequency of 1 mm/day.After distraction,the distractor was maintained for 3-6 months.At the second stage,the distractor was removed.Le Fort Ⅰ osteotomy was performed in order to correct the cross-bite and improve the facial contour.Usually,bone graft was inserted into the gap after Le Fort Ⅰ osteotomy.The genioplasty was also performed if necessary.Results 9 cases of adult hemifacialmicrosomia with severe mandibular deviation were treated.The facial asymmetry were improved greatly.1 patient suffered an wound infection in the maxillary region after Le Fort Ⅰ osteotomy and healed uneventfully with wound irrigation.Conclusions Mandibular distraction combined with orthognathic surgery is an effective procedure for adult hemifacial microsomia with complicated mandibular hypoplasia.