Discussion: Frontofacial Monobloc Distraction in the Very Young A Review of 12 Consecutive Cases
Discussion: Frontofacial Monobloc Distraction in the Very Young A Review of 12 Consecutive Cases
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讨论：幼儿额面部整体注意力分散 12 个连续病例回顾
DOI：
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发表时间：
2012
影响因子：
3.6
通讯作者：
R. Hopper
中科院分区：
文献类型：
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作者：
R. Hopper
通过对12名患者的回顾，来自Great Ormond Street的Fateh Ahmad先生和他的同事向我们提出了挑战，要求我们重新考虑对于一个出生时患有严重颅面骨发育不良的儿童来说，第一次颅面手术是什么。这篇文章描述了一个小系列的儿童，在生命的头两年，在一次手术中同时减压颅骨和颅下水平的整体额面部推进术。作者指出，在他们的机构中，早期的整体式额面推进已经取代了额眶推进。这篇文章的结果表明，与额眶前移相比，整体式额面前移具有提供类似程度的颅骨扩张的潜力，但具有更好的眼眶保护和鼻咽压缩的早期改善。刚刚超过一半的患者(12人中有7人)拔管，可能比3到4岁的早期Le Fort III手术早1到2年，而且得益于一次手术。目前尚不清楚的是，这种较早的鼻咽扩张和拔管是防止还是仅仅推迟了未来对进行性睡眠呼吸暂停和/或面中部后退进行Le Fort III手术的需要，1以及与单纯的颅骨扩张相比，风险和并发症是什么。该系列目前还太年轻，无法回答这些问题，但资深作者在他们之前发表的关于他们系列中第五名患者的病例报告中，最好地总结了早期单一额面推进的考虑因素：
W ith their retrospective review of 12 patients, Mr. Fateh Ahmad and colleagues from Great Ormond Street have challenged us to reconsider what the first craniofacial operation is for a child born with severe craniofacial dysostosis. This article describes a small series of children treated with monobloc frontofacial advancement in the first 2 years of life to decompress both cranial and subcranial levels in one operation. The authors state that the early monobloc frontofacial advancement has replaced the fronto-orbital advancement in their institution. The article’s results suggest that monobloc frontofacial advancement compared with frontoorbital advancement has the potential to provide a similar degree of cranial expansion but with improved orbital protection and an early amelioration of nasopharyngeal compression. Just over half (seven of 12) of the patients were decannulated, likely 1 to 2 years earlier than would have occurred with an early Le Fort III operation at 3 to 4 years of age, and with the benefit of a single operation. What is unclear is whether this earlier nasopharyngeal expansion and decannulation prevents or simply delays the need for a future Le Fort III procedure for progressive sleep apnea and/or midface retrusion,1 and what the risks and complications are compared with isolated cranial expansion. The series is currently too young to answer these questions, but the senior authors in their previously published case report of the fifth patient in their series best summarize the considerations of early monobloc frontofacial advancement: