馬蹄形骨切り併用Ｌｅ Ｆｏｒｔ Ｉ型骨切り術による上顎上方移動の確実性および術後安定性について

Abstract

Reliability of superior repositioning and postoperative stability of the maxilla in 11 non-cleft patients who underwent combination (Le Fort I and horseshoe) osteotomy for superior repositioning of the maxilla were investigated. In all patients, the maxilla was first osteotomized and fixed with four titanium miniplates. A bilateral sagittal split ramus osteotomy of the mandible (BSSRO) was then carried out and titanium screw fixation was performed. No maxillomandibular fixation with stainless steel wire was used postoperatively in any patient. Lateral cephalograms were obtained preoperatively, 2 weeks postoperatively, and 3, 6, and 12 months after surgery. The changes in the anterior nasal spine (ANS), point A (A), and point of maxillary tuberosity (PMT) were examined on the cephalograms. The discrepancy between the planned and measured superior repositioning of the PMT ranged from only 0.5 to 1mm (mean: 0.73mm). Therefore, the maxillae in the 11 subjects were repositioned nearly in their planned positions during surgery. In addition, no significant postoperative changes in the examined points of the maxilla were found. These results suggest that a combination of Le Fort I and horseshoe osteotomy is a useful technique for reliable superior repositioning of the maxilla, especially in its posterior portion. Moreover, the postoperative stability of the maxilla treated using this combination osteotomy is comparatively satisfactory.