双颌手术同期植骨矫治唇腭裂术后严重双颌畸形
[摘要]目的：总结分析高位Le Fort I 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Le Fort I 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牙合关系。 结论：高位Le Fort I 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。
, 百拇医药 [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
[中图分类号]R782.2R783.9[文献标识码]A[文章编号]1008-6455(2009)02-0169-04
Simultaneous bimaxillary orthognathic surgery and bone grafting for correction of secondary severe bimaxillary deformities in cleft patients
REN Min1，TENG Li2，SUN Xiao-mei2, GUI lai2
(1.Department of Breast Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China;2.Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100041，China)
, 百拇医药
Abstract： ObjectiveTo Summarize our experience in simultaneous high level Le Fort I osteotomy and sagittal split ramus osteotomy combining with bone grafting in the same operation for correction of secondary severe bimaxillary deformities in cleft patients.Methods From January 2002 to April 2006, 18 cleft patients suffering from secondary severe bimaxillary 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.ConclusionsHigh 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.
, 百拇医药
Key words： high level Le Fort I osteotomy；sagittal split ramus osteotomy；bone grafting；bimaxilary deformities；cleft palate
先天性唇腭裂术后常有继发严重的双颌畸形，表现为不同程度的凹面型、咬合紊乱、反牙合、开牙合、下颌相对或绝对前突等；不仅在咀嚼、发音等口腔功能方面具有不同程度的障碍，而且影响美观，给患者带来严重的心理压力，严重影响患者的社会生活质量，使其产生强烈的自卑感[1]。2002 年1 月～2006 年4 月，我们在总结其他学者各种改进方法及患者自身特点的基础上，将高位Le Fort I 型截骨术[2]与下颌升支矢状劈开截骨术[3]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患者18 例，效果良好。
1临床资料
1.1一般资料：本组男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。经临床及X 线片或螺旋CT 检查均有继发严重双颌畸形的主要表现：面中1/3 颌骨明显后缩，伴有下颌轻度或明显前突，前牙反牙合，部分开牙牙合。术前X线头影测量SNA 角77°～80°(正常值：82°±1°)， SNB角79°～82°(正常值：79°± 1°)，ANB角1°～-5°(正常值：3°± 1°)。, 百拇医药(任 敏 滕 利 孙晓梅 归 来)
, 百拇医药 [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
[中图分类号]R782.2R783.9[文献标识码]A[文章编号]1008-6455(2009)02-0169-04
Simultaneous bimaxillary orthognathic surgery and bone grafting for correction of secondary severe bimaxillary deformities in cleft patients
REN Min1，TENG Li2，SUN Xiao-mei2, GUI lai2
(1.Department of Breast Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China;2.Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100041，China)
, 百拇医药
Abstract： ObjectiveTo Summarize our experience in simultaneous high level Le Fort I osteotomy and sagittal split ramus osteotomy combining with bone grafting in the same operation for correction of secondary severe bimaxillary deformities in cleft patients.Methods From January 2002 to April 2006, 18 cleft patients suffering from secondary severe bimaxillary 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.ConclusionsHigh 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.
, 百拇医药
Key words： high level Le Fort I osteotomy；sagittal split ramus osteotomy；bone grafting；bimaxilary deformities；cleft palate
先天性唇腭裂术后常有继发严重的双颌畸形，表现为不同程度的凹面型、咬合紊乱、反牙合、开牙合、下颌相对或绝对前突等；不仅在咀嚼、发音等口腔功能方面具有不同程度的障碍，而且影响美观，给患者带来严重的心理压力，严重影响患者的社会生活质量，使其产生强烈的自卑感[1]。2002 年1 月～2006 年4 月，我们在总结其他学者各种改进方法及患者自身特点的基础上，将高位Le Fort I 型截骨术[2]与下颌升支矢状劈开截骨术[3]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患者18 例，效果良好。
1临床资料
1.1一般资料：本组男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。经临床及X 线片或螺旋CT 检查均有继发严重双颌畸形的主要表现：面中1/3 颌骨明显后缩，伴有下颌轻度或明显前突，前牙反牙合，部分开牙牙合。术前X线头影测量SNA 角77°～80°(正常值：82°±1°)， SNB角79°～82°(正常值：79°± 1°)，ANB角1°～-5°(正常值：3°± 1°)。, 百拇医药(任 敏 滕 利 孙晓梅 归 来)