北京大学学报(医学版) ›› 2016, Vol. 48 ›› Issue (3): 550-554. doi: 10.3969/j.issn.1671-167X.2016.03.030

• 论著 • 上一篇    下一篇

腭侧入路改良Le Fort Ⅰ型截骨术矫正唇腭裂继发上颌骨发育不足的临床初步应用

吴煜1,2,李自力1△,王兴1, 伊彪1, 马莲1   

  1. (1. 北京大学口腔医学院·口腔医院口腔颌面外科, 北京100081; 2. 北京大学第三医院口腔科, 北京100191)
  • 出版日期:2016-06-18 发布日期:2016-06-18
  • 通讯作者: 李自力 E-mail:kqlzl@sina.com

Transpalatal modified Le Fort Ⅰ osteotomy for correction of maxillary hypoplasia in cleft lip and palate patients: a preliminary clinical application

WU Yu1,2, LI Zi-li1△, WANG Xing1, YI Biao1, MA Lian1   

  1. (1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China; 2. Department of Stomatology, Peking University Third Hospital, Beijing 100191, China)
  • Online:2016-06-18 Published:2016-06-18
  • Contact: LI Zi-li1 E-mail:kqlzl@sina.com

摘要:

目的:评价腭侧入路改良Le Fort Ⅰ型截骨术矫正唇腭裂继发上颌骨发育不足畸形的临床效果。方法: 选取2012年1月至2013年12月于北京大学口腔医院行腭侧入路改良Le Fort Ⅰ型截骨术矫正唇腭裂继发上颌骨发育不足畸形的11例患者(男性7例,女性4例),平均年龄21岁(17~28岁),其中9例患者同期行双侧下颌升支矢状劈开截骨术(bilateral sagittal split ramus osteotomy,BSSRO)和颏成形术以获得良好的容貌。分别于术前、术后即刻、术后6个月时拍摄头颅定位侧位X线片,测量上齿槽座点(A)水平移动量、蝶鞍中心点-鼻根点-上牙槽座点角(angle of sella-nasion-subsipmale, SNA)和蝶鞍中心点-鼻根点-下牙槽座点角(angle of sellanasionsupramental, SNB)的度数以评价畸形矫正效果。结果: 所有患者均顺利完成手术,颌骨畸形矫正效果满意,咬合关系良好。术后即刻上颌骨A点水平前徙量平均为(6.6±1.1)mm,术后6个月时平均为(6.0±1.2)mm。SNA术前平均为75.9°±2.8°,术后即刻时平均为81.6°±8.6°,术后6个月时平均为81.0°±2.6°; SNB术前平均为82.6°±3.7°,术后即刻时平均为78.0°±2.4°,术后6个月时平均为78.5°±2.4°。结论: 腭侧入路改良Le Fort Ⅰ型截骨术可成功矫正唇腭裂术后继发上颌骨发育不足畸形,并获得良好的咬合功能;该术式术中解除了腭侧瘢痕组织的牵拉,能使上颌骨前移更充分,可获得满意的临床疗效。

关键词: 截骨术, Le Fort, 唇裂, 腭裂, 上颌骨发育不足

Abstract:

Objective:To evaluate the surgical corrective results of maxillary hypoplasia in patients with cleft lip and palate withtranspalatal modified Le Fort Ⅰ osteotomy. Methods: In the study, 11 patients (4 women, and 7 men) with maxillary hypoplasia secondary to cleft lip and palate underwent transpalatal modified Le Fort Ⅰ osteotomy at Peking University School of Stomatology from Jan. 2012 to Dec. 2013,with the mean age of 21 years ( from 18 to 27 years), Bilateral sagittal split ramus osteotomy (BSSRO)and genioplasty were performed simultaneously in 9 of them for better appearance and functional occlusion. Lateral cephalometric radiographs were taken and traced before surgery, immediately after surgery and 6 months after surgery. The position of subspinale (A) on horizontal direction, the angle of sella-nasion-subsipmale (SNA) and the angle of sella-nasion-supramental (SNB) were collected and analyzed to evaluate the results. Results: All the patients were uneventful with transpalatal modified Le Fort Ⅰ osteotomy. All of them had a better profile and a satisfactory occlusionafter operation.The position of A was moved forward (6.6±1.1) mm on average in horizontal direction when surgery was completed, and maintained (6.0±1.2) mm on average 6 months after surgery. The average of SNA was 75.9°±2.8° before surgery,81.6°±8.6° immediately after surgery, and maintained 81.0°±2.6° 6 months after surgery. The average of SNB was 82.6°±3.7° before surgery, 78.0°±2.4° immediately after surgery, and maintained 78.5°±2.4° 6 months after surgery. Conclusion: The maxillary hypoplasia in cleft lip and palate patients can be successfully corrected with transpalatal modified Le Fort Ⅰ osteotomy and the functional occlusion can be achieved simultaneously. The effect of deformity correction was satisfactory. Transpalatal modified Le Fort Ⅰ osteotomy can move maxilla more sufficiently, especially applicable for the patient with severe palatal scars preoperatively.

Key words: Osteotomy, Le Fort, Cleft lip, Cleft palate, Maxillary hypoplasia

中图分类号: 

  • R782.2
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