Abstract：
Fronto-facial monobloc advancement with internal distraction (FFMBA) is a central procedure in the management of faciocraniosynostoses. In techniques with internal distraction, two sets of devices are generally positioned: bilateral fronto-orbital and temporo-zygomatic distractors, using a temporal tongue and groove osteotomy design. It is believed that distractors must be positioned as parallel as possible in the horizontal and sagittal planes to avoid mechanical conflicts between the sliding bone fragments of the tongue and groove during distraction, and thus optimize the advancement amplitude. Several approaches involving surgical planification and guides for distractor positioning have thus been proposed to monitor distractor placement. To explore the need for surgical planification in distractor placement, the parallelism of the position of the 4 distractors was assessed in 19 FFMBA procedures and we correlated a set of 10 distractor angles with the degree of advancement. We report that the horizontal cut of the tongue and groove can be used as a landmark for the positioning of the lower, temporo-zygomatic, distractor in fronto-facial monobloc advancement. Other parameters (relative position of the two homolateral and the two contralateral distractors and the orientations of the vertical and horizontal cuts of the tongue and groove) do not interfere with distraction, other things being equal. Our results indicate that distractor orientation is not a critical issue in fronto-facial monobloc advancement when devices are positioned as parallel as possible based on visual monitoring.
摘要：
具有内部分散注意力的面部整体前进（FFMBA）是治疗面交融术的核心程序。在内部分心的技术中，通常有两套装置:双侧前眶和颞颧骨牵引器，采用颞部舌沟截骨设计。据信，撑开器必须在水平面和矢状面中尽可能平行地定位，以避免在撑开过程中舌头和凹槽的滑动骨碎片之间的机械冲突，从而优化推进幅度。因此,已经提出了涉及外科手术平面化和用于撑开器定位的引导件的几种方法来监测撑开器的放置。为了探索在分心器放置中进行手术平面化的必要性，在19个FFMBA程序中评估了4个干扰物位置的平行性,我们将一组10个干扰物角度与推进程度相关联.我们报告说，榫槽的水平切口可以作为下定位的地标，颞骨,前脸整体推进中的干扰因素。其他参数（两个同侧和两个对侧撑开器的相对位置以及舌头和凹槽的垂直和水平切口的方向）不会干扰撑开，其他条件是平等的。我们的结果表明，当设备基于视觉监控尽可能平行地定位时，在正面整体前进中，分心器的方向不是关键问题。
