반안면소체 교정에 있어서 구강내 신장기 및 구강외 신장기 사용의 비교 분석

Abstract

Numerous surgical procedures have been advocated to correct the facial deformity in patients with hemifacial microsomia, including chondrocostal grafts, mandibular osteotomies combined with bone grafts, and maxillary osteotomies done at an early age after permanent dentition is completed. The standard treatment of these malformations consists of the application of bone grafts which can lead to unpredictable growth. Furthermore, these procedures often require intermaxillary fixation, blood transfusions and sometimes tracheostomies. Lengthening of the mandible by gradual distraction, according to the method of Ilizarov, opens new perspectives for interceptive therapy. Laboratory and clinical studies have shown that mandibular distraction is an effective and powerful reconstructive surgical technique. Lengthening of the mandible by gradual distraction was performed on five patients of hemifacial microsomia and one patient of Goldenhar syndrome using unidirectional or bidirectional extraoral device and intraoral device. In two patinets, simultaneous mandibular and maxillary distraction was performed with incomplete Le Fort I osteotomy. The amount of mandibular bone lengthening ranged from 8 to 21 mm, the patinets were maintained in fixation for an average of 12 weeks to allow ossification. There was no severe perioperative complication and the length of clinical follow-up ranged from 3 to 17 months. The skeletal change resulting from directional bone lengthening could be seen best by comparing the pre-and postoperative 3-D CT scans. There was also the potential for improvement in neuromuscular function(functional matrix), attendant growth and development of the affected jaw. Mandibular distraction is a simple procedure with minimal morbity and complications, so the results to date indicated that the technique can be applied to the correction of hemifacial microsomia. The development of new devices should permit multidirectional mandibular distraction and craniofacial distraction to allow early reconstruction of cranio-maxillofacial malformations. Distraction osteogenesis for reconstruction of the mandible in this subest of young patients was a safe and effective technique for improving the craniofacial skeletal form and appearance, with minimal associated morbidity. Key Words: Distractor ,Hemifacial microsomia ,Distraction osteogenesis

지난 2년동안 하악골 형성부전이 있는 반안면소체 환자에게 골이식 등의 광범위한 수술이 아니라 비교적 간단한 절골술과 신장기에 의한 골연장술로 다양한 시행착오를 겪으며 골결손을 재건해 주었다. 이것은 약 5세경의 비교적 어린 나이에도 시작할 수 있고 골신장은 또한 안면부와 경부의 모든 연부조직(피부, 근육, 혈관, 신경)의 팽창도 일어나게 해 훨씬 더 좋은 미용적 결과를 얻을 수 있다. 하지만 아직까지 신장기의 한계성으로 합병증이나 과소교정 등이 일어날 수 있어 사용에 있어서 신중을 기해야 하며 장기간의 추적결과를 토대로 수술시기, 신장기간 등의 정확한 지침을 연구해야 할 것이다.