背景:尽管由于上颌骨-下颌骨不对称,最终结果并不总是(美学上)令人满意,但颅面微体(CFM)的下颌骨重建已经得到了详细的描述和回顾,哪些最佳校正技术仍不清楚。本系统综述的目的是概述单侧CFM患者上颌矫正的手术选择。
方法:MEDLINE/Pubmed,Embase,Cochrane和WebofScience数据库的搜索时间截至2017年4月15日。纳入标准为:研究报告单侧CFM(n>4)患者进行上颌矫正(有/没有同时下颌矫正),最少随访6个月。结果测量包括治疗类型(包括之前的面部手术),下颌畸形的类型和严重程度(通过Pruzansky-Kaban系统:I/IIa/IIb/III型),不对称分析方法,结果(即闭塞,canting,稳定性,美学结果,面部对称性),并发症和需要额外的治疗。
结果:9项研究符合纳入标准。分析显示LeFortI+下颌骨牵张成骨(LeFort+MDO)和双上颌骨截骨术(BiMax)用于治疗,作为单级或多级程序。所有研究都报告了美学和功能的改善。
结论:I/IIa型受益于LeFort+MDO;IIb型受益于LeFort+MDO或BiMax;III型受益于BiMax(50%的病例先前有下颌手术,包括适合患者的假体),平均年龄为20.2岁。四项研究推荐了额外的(美学)程序。
BACKGROUND: Mandibular reconstruction in craniofacial microsomia (CFM) has been described and reviewed at length although final results are not always (aesthetically) satisfactory due to maxillo-mandibular asymmetry, for which optimal correction techniques remain unclear. The aim of this systematic
review is to provide an overview of the surgical options for maxillary correction in patients with unilateral CFM.
METHODS: MEDLINE/Pubmed, Embase, Cochrane and Web of Science databases were searched up to April 15, 2017. Inclusion criteria were: studies reporting patients with unilateral CFM (n > 4) who had maxillary correction (with/without simultaneous mandibular correction) with a minimal follow-up of 6 months. The outcome measures included type of treatment (including preceding facial procedures), type and severity of mandibular deformity (by Pruzansky-Kaban system: Types I/IIa/IIb/III), asymmetry analysis method, outcome (i.e. occlusion, canting, stability, esthetic result, facial symmetry), complications and additional treatment needed.
RESULTS: Nine studies met the inclusion criteria. Analysis showed that Le Fort I + mandibular distraction osteogenesis (LeFort + MDO) and BiMaxillary osteotomy (BiMax) were used for treatment, as single or multiple-stage procedures. All studies reported aesthetic and functional improvement.
CONCLUSIONS: Types I/IIa benefited from LeFort + MDO; Type IIb from LeFort + MDO or BiMax; and Type III from BiMax (with 50% of cases having preceding mandibular procedures, including patient-fitted prosthesis) at a mean age of 20.2 years. Four studies recommended additional (esthetic) procedures.