Maxillary Advancement in Cleft Patients by Means of Transantral Distraction: Development of a New Type of Distraction Device and Pilot Study of Its Clinical Application
Maxillary Advancement in Cleft Patients by Means of Transantral Distraction: Development of a New Type of Distraction Device and Pilot Study of Its Clinical Application
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经鼻窦牵引上颌骨前移：新型牵引装置的研制及其临床应用的初步研究
DOI：
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发表时间：
2005
影响因子：
3.6
通讯作者：
H. Umstadt
中科院分区：
文献类型：
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作者：
H. Umstadt
在单期手术中，在分离的上颌复合体良好活动后，非唇裂患者的最大前移可达到10~12 mm。然而，手术中上颌骨向前推进的距离越大，导致的骨骼复发就越大。1供应该区域的血管和附着在其上的软组织是有弹性的，它们共同施加力量，将上颌骨拉回其原始位置，并发生复发。2-4通过钢板接骨术和/或在翼上颌裂中植入自体骨块，有可能在有限程度上减少这种趋势。5在以前手术过的唇腭裂患者中，情况要差得多。在这组患者中，上颌经常不仅明显后移，而且在垂直方向上也显示出明显的缺陷。对于已经接受过多次手术的唇裂患者，疤痕组织增加了软组织和血管所施加的导致复发的力量。3疤痕形成还使术中活动比非唇裂患者困难得多，并增加了复发的程度。3、6-8在上颌向前推进了很长一段时间后，复发的程度相当大，1、3、9导致超过10%的病例需要再次手术。10因此，对于唇裂患者的单期上颌骨前移，即使在手术计划阶段，也有必要进行广泛的过度矫正。这不仅使最终结果更难预测，还带来了上颌骨坏死的风险，因为唇裂患者该区域的血液供应可能会因疤痕形成而受到抑制。自1992年以来，已尝试通过牵引成骨来解决口腔、颌骨和面部软组织和骨骼缺乏的问题。12口腔内和口腔外都使用了各种牵张器。11、13-17这些方法的复发率似乎低于传统方法。18、19然而，这些牵引术也存在问题。它们可以概括为以下几点。如果牵引器口腔内固定到上颌骨外表面，总体上是凸起的，则牵引器与骨面的距离相对较大。这反过来又会导致空间问题和种植体周围的炎症。只有在极少数情况下，才有可能安装一对与法兰克福水平面成角度平行和定向的牵引器。口外固定牵引器的缺点是三维效果相对较差。
In a single-stage procedure, a maximal advancement of 10 to 12 mm can be achieved in noncleft patients after good mobilization of the separated upper jaw complex. The greater the distance through which the upper jaw is operatively advanced, however, the greater the resulting skeletal relapse.1 The blood vessels supplying the area and the soft tissue attached to them are elastic and together they exert a force pulling the upper jaw back toward its original position and relapse occurs.2–4 It is possible to decrease this tendency to a limited extent by means of plate osteosynthesis and/or interposition of an autologous bone block in the pterygomaxillary fissure.5 In patients with a cleft lip or palate that has previously been operated on, the situation is much less favorable. In this group of patients, the upper jaw is often not only markedly retrodisplaced, but also shows a clear deficit in the vertical dimension. In cleft patients who have already undergone multiple operations, scar tissue adds to the force leading to relapse that is exerted by the soft tissue and blood vessels.3 Scarring also makes intraoperative surgical mobilization considerably more difficult than in noncleft patients and increases the magnitude of relapse.3,6–8 After advancement of the upper jaw through large distances, the extent of relapse is considerable,1,3,9 leading to reoperation in over 10 percent of cases.10 In single-stage maxillary advancement in cleft patients, it is therefore necessary to carry out extensive overcorrection, even at the surgical planning stage. Not only does this make the end result less predictable, it also brings with it the risk of maxillary necrosis because the blood supply of the area in cleft patients can be inhibited as a result of scarring. Since 1992,11 attempts have been made to solve the problem of the lack of soft tissue and bone availability in the mouth, jaw, and facial area by means of distraction osteogenesis.12 A variety of distraction devices have been used both intraorally and extraorally.11,13–17 The relapse rate seems to be lower with these methods than with the conventional procedure.18,19 However, there are also problems associated with these distraction procedures. They can be summarized as follows. If the distractors are fixed intraorally to the outer surface of the maxilla, which is convex overall, the distance between them and the bone surface is relatively large. This in turn leads to space problems and peri-implant inflammation. Only in very few cases is it possible to attach a pair of distractors parallel and targeted with respect to their angle to the Frankfort horizontal plane. Extraorally fixed distractors have the disadvantage of relatively poor three-dimensional