골신연술에 의한 성인 구순구개열자의 중안면함몰의 개선
Treatment of midface deficiency on adult cleft Lip and palate individuals by distraction osteogenesis
손우성, 김종렬, 강상욱, 강대근,
소속 상세정보
손우성 ( Son Woo-Sung ) - 부산대학교 치의학전문대학원 치과교정학교실
김종렬 ( Kim Jong-Ryoul ) - 부산대학교 치의학전문대학원 구강악안면외과학교실
강상욱 ( Kang Sang-Wook ) - 부산대학교 치의학전문대학원 교정학교실
강대근 ( Kang Dae-Geun ) - 부산대학교 치의학전문대학원 교정학교실
KMID : 0360120090310010053
Abstract
Maxillary deficiency, anterior cross bite, constriction of maxillary arch, malaligned teeth are frequently observed in patients with cleft lip and palate. Surgery and orthodontics, combined intervention are needed to correct maxillary deficiency. Distraction osteogenesis that currently used has many advantages like less relapse tendency, more advancement of maxilla, capable in growing patients. In case 1, 18 years old girl with BCLP had severe midfacial deficiency and multiple missing of teeth. LeFort I osteotomy, followed by maxillary distraction osteogenesis utilizing rigid external distraction device(RED) system, was performed. After a 6-day latency period, distraction proceeded at a rate of 1mm per day (at 1st week, 1.5mm/day). Total advancement was 19mm. The RED device left in place for the additional 4 weeks for consolidation. After the RED device was removed, face mask was applied with elastic traction for 5 weeks. After achieving acceptable facial appearance and occlusion, orthodontic appliance was removed. The results after 4 years follow-up was sustained pretty well without aggravation of velopharyngeal function. In case 2, 22 years old man with UCLP had severe midfacial deficiency and palatally erupted upper 2nd premolars due to arch length discrepancy, but the anterior segment of maxillary did not show constriction and crowding. patient had no arch width discrepancy, crowding was concentrated on premolar region. Segmental LeFort I osteotomy was performed. After a 6 - day latency period, using internal distraction device, distraction proceeded at a 0.5mm per day(at 1st week, 0.75 - 1 mm/day). Total advancement was 15mm. After internal distraction device was removed, face mask was applied with elastic traction for 4 weeks. After surgicalorthodontic treatment, facial appearance and occlusion was improved pretty good, and after 46 months follow- up the result was retained well.
키워드
Cleft lip and palate;Extraoral/Internal distraction osteogenesis
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