鼻底缝合对LeFortI型截骨鼻形态的影响

上颌ＬｅＦｏｒｔⅠ型截骨移动上颌骨后可导致鼻形态的变化[1 ] ,了解二者之间的关系对手术的设计及术后面容的预测有较大意义。1　对象与方法1990～ 1998年收治上颌后缩患者 2 4例。所有患者均接受上颌ＬｅＦｏｒｔⅠ型截骨 ,其中 12例 (男 7例 ,女 5例 ,年龄 19～ 31岁 )未进行鼻底缝合 ;另 12例 (男 8例 ,女 4例 ,年龄 15～ 36岁 )利用可吸收缝线或普通丝线将两侧鼻翼软骨基部纤维组织行埋入缝合。根据术前所测量的鼻翼宽度及形态决定缝合的松紧度 (图 1) ,缝合后的鼻翼宽度应略低于术前2～ 3ｍｍ ,术前鼻翼较宽者缝合可略紧 ,则术后鼻翼…     

三维CT在上颌发育不足患者行Le Fort Ⅰ型截骨术中的应用

目的 采用三维CT影像对下颌前突、上颌发育不足患者的上颌硬组织进行测量分析,以期为临床Le Fort Ⅰ型截骨术提供指导.方法 2009年6月至2011年2月在中国医科大学附属口腔医院就诊的40例患者,随机分为2组,20例行上颌骨Le Fort Ⅰ型截骨的患者作为实验组,20例单纯下颌骨骨折为对照组,进行颅颌面部CT扫描.应用软件Surgicase5.0对颅颌面部CT影像进行三维重建后,测量腭降动脉和翼板相关结构,并对所得数据进行统计学分析.结果 梨状孔边缘至翼腭管的距离实验组平均为(33.74±6.74) mm,对照组平均为(35.67±7.50) mm,二者比较,差异有统计学意义(P＜0.05).而翼上颌连接的高度,实验和对照组比较,差异无统计学意义(P＞0.05).结论 下颌前突,上颌发育不足患者行Le FortⅠ型截骨的安全距离约为32 mm,在手术过程中应注意控制骨切开深度;有必要对Le Fort Ⅰ型截骨术患者术前拍摄上颌骨CT及进行相关测量为手术提供指导.     

上颌骨Le Fort Ⅰ型截骨前移术后鼻腔通气功能的变化

目的 评估上颌骨Le Fort Ⅰ型截骨上颌骨前移术对鼻腔通气功能的影响.方法 对13例Ⅲ类错颌畸形患者进行前瞻性的研究,年龄18 ～35岁,手术方案包括上颌骨Le Fort Ⅰ型单块截骨并前移.术前3d及术后3、6个月对研究对象分别进行前鼻镜及鼻声反射检查.术前3d、术后6个月,对所有研究对象进行NOSE量表的主观性评估.并对术前及术后的结果进行统计学分析.结果 鼻声反射检测结果显示术前3d及术后3、6个月鼻腔总阻力分别为(1.189±0.38)cm H2O/L/mi、(1.081±0.43) cm H2O/L/mi和(1.111±0.40) cm H2O/L/mi,鼻腔总容积分别为( 14.920±1.95) ml、(16.380±4.32)ml和(15.660±4.25) ml,鼻腔平均截面积分别为(0.500±0.09) cm2、(0.570±0.15) cm2和(0.560±0.14) cm2,但术前后比较差异无统计学意义(P＞0.05).NOSE量表的主观性评估结果显示,术后6个月时的评估分值较术前下降,即主观症状改善,术前、后比较差异无统计学意义.结论 上颌骨Le Fort Ⅰ型单块截骨上颌骨前移手术不会对患者的鼻腔通气功能产生不良影响.同时利用客观性检测(鼻声反射检测)及主观性检测(NOSE量表)手段可以有效地对鼻腔结构及功能进行评估.     

上颌骨Le Fort-Ⅰ型截骨术坚强内固定的有限元研究

目的 研究不同接骨板在上颌骨Le Fort-Ⅰ型截骨正颌手术中固定的生物力学特性,以期找出最佳固定方法.方法 建立正颌Le Fort-Ⅰ型截骨9种内固定方式的三维有限元模型,并分为3组,计算不同固定方法在3种咬合情况下上颌骨的应力及截骨段的位移,对比不同内固定系统,不同形状接骨板,以及接骨板不同放置位置的固定效果.结果 前牙咬合时,颅、上颌复合体中应力主要循双侧鼻上颌支柱向上传递,前磨牙和磨牙咬合时,应力先自咬合处向牙槽突两侧传递,再分别循颈上颌支柱和鼻上颌支柱传递;内固定系统中螺钉与接骨板交接处及接骨板近截骨线处,为应力集中部位.前磨牙咬合时,不同固定方法截骨段位移从大到小依次为:组1 生物可吸收小型板系统(0.396 509 mm)、微型钛板(0.148 393 mm)、小型钛板(0.078 436 mm);组2 单纯鼻上颌支柱固定(0.188 791 mm)、颧上颌支柱固定(0.12l 718 mm)、双支柱固定(0.078 436 mm);组3 直形板(0.091 023 mm)、L形板(0.078 436 mm)、Y形板(0.072 450 mm)、T形板(O.065 617 ram).结论 正颌Le Fort-Ⅰ型截骨术生物可吸收接骨板固定的稳定性和强度相对钛板较小;颧上颌支柱固定效果好于鼻上颌支柱固定;不同形状的钛板在鼻上颌支柱固定的稳定性有差异.     

上颌前部截骨术对上颌前突患者鼻部形态的影响

目的 探讨上颌前部截骨术对上颌前突患者鼻部形态的影响.方法 2015年1月至2019年4月,共收治女性上颌前突畸形患者41例.所有患者行上颌前部截骨后推术,并于术前及术后10～12个月行头颅CT平扫.以mimics17.0软件对手术前后CT扫描结果进行三维重建,测量手术前后各解剖标记的三维数据,系统分析患者鼻部软组织变...     

经口内切口的上颌骨额突截骨术

采用Joseph专用手术器械,经鼻孔内人路或鼻孔外入路缩窄鼻背宽度,仍是临床上被普遍采用的方法.我们经上颌齿龈缘小切口,手术采用微型来复锯行上颌骨额突截骨术矫治鼻背过宽和驼峰鼻118例,获得满意的临床效果,现报告如下.     

Le Fort Ⅲ型截骨牵引术后上气道不同截面面积变化的研究

目的 通过对中面部行Le Fort Ⅲ型截骨牵引术前、术后上气道不同截面面积的比较,评价截骨前移手术对严重中面部发育不良所致骨性上气道狭窄的治疗效果.方法 自2000年以来,对11例严重中面部发育不良者,选用Le Fort Ⅲ型颅面部截骨牵引进行治疗.术前、术后计算机辅助测量上气道不同部位二维截面面积,部分病例术前、术后行多导睡眠监测功能评估.结果 所有病例面部外形及通气功能改善明显.术后后鼻棘点和腭垂尖点气道平面截面面积平均增加(210.33±219.34)mm2和(65.14±42.24)mm2,与术前比较,差异有统计学意义(P＜0.05);而会厌点及气道食道分界点截面面积术后未见明显增加(P＞0.05).结论 Le Fort Ⅲ型截骨牵引术前移中面部能有效改善因中面部严重发育不良所致的上气道狭窄,气道狭窄的改善以腭垂尖点以上气道改善最为显著.     

下颌角弧形截骨术对咀嚼功能的影响

目的 通过对下颌角弧形截骨手术前后咬合力的研究,分析手术对咀嚼功能的影响,从而进一步指导临床.方法 对2008年1至10月行下颌角弧形截骨术的20例女性患者(年龄16～38岁)手术前后切牙区、双侧前磨牙区、双侧磨牙区最大咬合力进行测定,比较手术前及术后6个月时咬合力的变化.结果 术前前牙区、右侧前磨牙区、左侧前磨牙区、右侧磨牙区、左侧磨牙区最大咬合力分别为:(11.7±3.9)kg、(23.2±1.6)kg、(30.9±2.3)kg、(35.6±4.2)kg、(38.5±3.1)kg.术后6个月测定的最大咬合力分别为:(11.9±2.1)kg、(23.0±4.5)kg、(31.0±1.8)kg、(35.9±3.5)kg、(38.5±2.7)kg,各牙区最大咬合力达到甚至略高于术前水平.术后6个月与术前比较差异无统计学意义(P>0.05).结论 下颌角弧形截骨手术对最大咬合力及咀嚼功能无明显影响.     

上颌Le Fort Ⅰ型截骨术后控制鼻翼宽度的两种手术方法效果比较

目的 比较两种鼻翼基底缩窄术(alar base suturing,ABS)控制上颌Le Fort Ⅰ型截骨术后鼻翼宽度的效果.方法 55例牙颌面畸形患者,均接受了上颌Le Fort Ⅰ型截骨或分块截骨术,按随机数表分为实验组(27例)和对照组(28例).实验组采用口外入路ABS,对照组采用口内入路ABS.采用3dMD立体照相测量法,于术前、术后3个月拍摄患者面部三维照片,定点测量鼻部形态变化,测量结果进行t检验.结果 术后3个月与术前相比,对照组鼻翼最外侧点间距增加(1.38±1.29) mm,鼻翼基底最外侧点间距平均增加(1.06 ±0.95) mm,鼻翼基底点间距平均增加(0.36±1.13) mm.实验组鼻翼最外侧点间距平均增加(2.66±1.47) mm,鼻翼基底最外侧点间距平均增加(2.20±1.22) mm,鼻翼基底点间距平均增加(1.30±1.33)mm.实验组与对照组比较差异有统计学意义(P＜0.05).结论 ABS两种术式对鼻翼基底缩窄的效果均优于对鼻翼最外侧点缩窄的效果,口内人路法效果优于口外入路法,但两种方法均无法完全控制术后鼻翼增宽的趋势.     

The difficult Le Fort I osteotomy and downfracture: a review with consideration given to an atypical maxillary morphology.

SUMMARY: The Le Fort I osteotomy of the maxilla continues to be one of the most common techniques used in the surgical correction of a variety of dento-midfacial deformities. The procedure is generally considered to be operatively safe and postoperatively stable. Occasionally, however, surgeons may encounter difficulties during horizontal sectioning of the jaw, pterygomaxillary separation and or downfracture. In such cases, the steps leading up to and including the undertaking of a 'difficult' downfracture may put the patient at an increased risk of developing complications. The preoperative identification of potentially difficult cases, and in particular where evidence is suggestive of an atypical maxillary morphology, is extremely important in order to prevent or minimise the likelihood of a complication. In outlining some examples of such cases, we highlight the need to consider more exhaustive preoperative imaging of the maxilla and proffer some specific operative steps that can be employed to facilitate downfracture.     

Comparison of maxillary stability after Le Fort I osteotomy for occlusal cant correction surgery and maxillary advanced surgery.

OBJECTIVE: To compare postoperative maxillary stability following Le Fort I osteotomy for the correction of occlusal cant as compared with conventional Le Fort I osteotomy for maxillary advancement. STUDY DESIGN: The subjects were 40 Japanese adults with jaw deformities. Of these, 20 underwent a Le Fort I osteotomy and intraoral vertical ramus osteotomy (IVRO) to correct asymmetric skeletal morphology and inclined occlusal cant. The other 20 patients underwent a Le Fort I osteotomy and sagittal split ramus osteotomy (SSRO) to advance the maxilla. Lateral and posteroanterior cephalograms were taken postoperatively and assessed statistically. Thereafter, the 2 groups were followed for time-course changes. RESULTS: There was no significant difference between the 2 groups with regard to time-course changes during the immediate postoperative period. CONCLUSION: This suggests that maxillary stability after Le Fort I osteotomy for cant correction does not differ from that after Le Fort I osteotomy for maxillary advancement.     

Modified Le Fort I osteotomy with preservation of the anterior nasal spine position: preliminary report.

We present a modification of the traditional Le Fort I osteotomy by means of which the anterior nasal spine is left intact. The osteotomies advance from the posterior-lateral side of the maxillary bone through the tuberosity to the inferior-lateral wall of the piriform opening. Two other vertical osteotomies from the lateral side of the piriform opening are placed in a 90 degree fashion to connect with another horizontal osteotomy that runs 5 mm below the floor of the nasal cavity and the anterior nasal spine. In a series of 50 patients with Le Fort I osteotomies, we have performed this new technique in 5 patients. We have observed better esthetic results in terms of nasal tip position and a more predictable value for the nasolabial angle. We believe that this technique is more appropriate for larger advancements in which a large gap may occur at the end of the movement.     

Subarachnoid hemorrhage as a complication of Le Fort I osteotomy

We report a case of subarachnoid hemorrhage (SAH) and carotid cavernous fistula (CCF) caused by Le Fort I osteotomy. A 16-year-old boy was scheduled to undergo Le Fort I osteotomy for a cleft lip and palate. After down fracture was completed, more than 1000 ml of bleeding was observed. When he became concious, we found anisocoria and imcomplete paralysis in the left side of his body. CT and angiography showed CCF and SAH to be present. After coil embolisation for CCF and therapeutic hypothermia had been performed, he recovered without severe neurological deficits. We should remember that unexpected mass bleeding in this surgery would suggest the incidence of intracranial vascular injuries.     

A simple technique to facilitate the Le Fort I osteotomy downfracture.

In order to mobilize and reposition the maxilla when treating dentofacial deformities, the Le Fort I maxillary osteotomy is commonly used. Like other surgical procedures, this procedure is not without inherent difficulties. At times, it may be difficult to initially mobilize the maxilla after performing the osteotomies. Techniques used to help in the initial mobilization and downfracture of the maxilla from the pterygoid plates include digital pressure to the dentoalveolus, disimpaction forceps, spreaders, and other instruments. These techniques are similar in that they all apply a unidirectional downward vector of force on the maxilla and have various drawbacks. We present a technique that uses a 0.5-mm stainless steel traction wire to facilitate Le Fort I maxillary downfracturing by applying a forward and downward vector of force simultaneously. After vertical downfracture of the maxilla, lateral traction on the wire can be used to complete the pterygomaxillary disjunction. This technique has several advantages and is atraumatic, and requires no special instrumentation; thus, downfracturing of the maxilla is done with relatively little effort and minimal risk.     

Le FortⅠ型截骨后眶下神经损伤和恢复的研究

目的 探讨Le ForⅠ型截骨后眶下神经(inferorbital nerve，ION)暂时和永久性损伤的发生率和感觉恢复的时间。方法 随机选择30例Le FortⅠ型截骨的病例，采用针刺检测、两点分辨觉法和直流感应电测仪测定ION分布区域感觉和恢复时间。结果 ION暂时性损伤为75％(45／60)，ION感觉1～3个月明显恢复。结论 Le FortⅠ型截骨后ION感觉障碍是暂时性的，一般在1～3个月恢复，未见永久性神经损伤。