Konjenital Nonsendromik Dentofasiyal Deformitelerde Distraksiyon Osteogenezi

Year 2016, Volume: 2 Issue: 3, 119 - 126, 01.01.2016

Ersoy Konaş Gökhan Tunçbılek

Abstract

Konjenital fasiyal deformiteler gerek mevcut deformite, gerekse deformitenin gelişim sürecindeki yansıması olarak görülebilmektedir. Gelişimsel sorunlar sıklıkla mandibula veya orta yüz bölgesinde maksilla gelişiminde beliren yetersizlik ve buna bağlı olarak çevre dokularda oluşan orantı problemleri ile kendisini göstermektedir. Gelişim geriliğinin en önemli nedenleri arasında yapılan onarım sonrası ortaya çıkan skarın kemik gelişimini engellemesi , kemiğin gelişim odağının deforme olması ve çevre yumuşak doku eksiklikleri sayılabilmektedir. Kemik augmentasyonunu gerektiren fasiyal konjenital deformiteler arasında; Pierre-Robin sekansı, dudak damak yarıklarına sekonder orta yüz gerilikleri, kraniofasiyal mikrozomi sayılabilir. Sözü edilen deformite spektrumu, klasik ortognatik cerrahi veya distraksiyon osteogenezi ile kemik yapının restorasyonu ve bunlara ek olarak yumuşak doku augmentasyonları ile rekonstrükte edilebilmektedir. Kemik doku restorasyonunda ilerletme olanaklarının daha fazla olması,yeni kemik elde edilebilmesi, serbest doku nakli gereksinimini azaltması ve daha stabil bir onarım imkanı sağlaması nedenleri ile distraksiyon osteogenezi son yılarda daha etkin bir tedavi yöntemi olarak görülmektedir

Keywords

Fasiyal deformite, Dudak damak yarığı, Distraksiyon osteogenezi, Fasiyal gelişim, Pierre-Robin sekansı, Ortognatik cerrahi, Kraniofasyal mikrozomi

Konjenital Nonsendromik Dentofasiyal Deformitelerde Distraksiyon Osteogenezi Distraction Osteogenesis in Congenital Nonsyndromic Dentofacial Deformities

Abstract

Congenital deformities in the face occur due to accompanying congenital facial deformity or developmental problems secondary to deformities. Scar formation after surgery or soft tissue deficiencies around the deformity may enhance the developmental problems. The most common congenital facial deformities requiring skeletal correction are deformities secondary to cleft lip and palate, Pierre-Robin Sequence, and craniofacial microsomia. All these deformities can be treated with bony advancement with classical orthognathic surgery or distraction osteogenesis and soft tissue augmentation procedures. The treatment planning for these deformities is complex and difficult, because the required amount of bony advancement is generally quite large and there is inadequate soft tissue coverage of the area. Orthognathic surgery is more difficult to perform in cleft lip and palate cases and impossible for the micrognathic newborn. Due to longer and more stable advancement opportunities, distraction osteogenesis has become more popular in bony restoration of congenital facial deformities

Keywords

Facial deformity, Pierre-Robin Sequence, Craniofacial microsomia, Cleft lip-palate, Distraction osteogenesis, Maxillofacial development, Orthognathic surgery

References

• Li Y, Shi B, Song Q-G, Zuo H, Zheng Q. Effect of lip repair on maxillary growth and facial soft tissue development in patients with a complete unilateral cleft of lip, alveolus and palate. J Craniomaxillofac Surg 2006; 34:355–61.
• Mars M, Houston WJ. A preliminary study of facial growth and morphology in unoperated male unilateral cleft lip and palate subjects over 13 years of age. Cleft Palate J 1990; 27:7–10.
• Sommerlad BC, Henley M, Birch M, Harland K, Moiemen N, Boorman JG. Cleft palate re-repair e a clinical and radiographic study of 32 consecutive cases. Br J Plast Surg 1994; 47:406-10.
• Management of infants with Pierre Robin sequence. Cleft
• Palate Craniofac J 2003; 40:180–5.
• Monasterio FO, Molina F, Berlanga F, López ME, Ahumada H, Takenaga RH, Ysunza A. Swallowing disorders in Pierre Robin sequence: Its correction by distraction. J Craniofac Surg 2004;15:934-41.
• Genecov DG, Barceló CR, Steinberg D, Trone T, Sperry E. Clinical experience with the application of distraction osteogenesis for airway obstruction. J Craniofac Surg 2009; 20 Suppl 2:1817-21.
• Caoutte-Laberge L, Bayet B, Larocque Y. The Pierre Robin sequence: Review of 125 cases and evolution of treatment modalities. Plast Reconstr Surg 1994; 93:934- 42.
• Tomaski S, Zalzal G, Saal H. Airway obstruction in the Pierre Robin sequence. Laryngoscope 1995; 105:111-4.
• McCarthy JG, Grayson B, Coccaro PJ, Wood-Smith D. In: McCarthy JG, ed. Craniofacial microsomia in plastic surgery. Philadelphia: W. B. Saunders Company, 1990.
• Gorlin RJ, Pindburg JJ, Cohen MM: Syndromes of the Head and Neck, 2nd ed. New York: McGraw-Hill, 1976.
• Converse JM, Wood-Smith D, McCarthy JG, Coccaro PJ, Becker M. Bilateral facial microsomia: Diagnosis, classification, treatment. Plast Reconstr Surg 1974; 54:413.
• Murray JE, Kaban LB, Mulliken JB, Evans CA. Analysis and treatment of hemifacial microsomia. In: Caronni EP, ed. Craniofacial surgery. Boston: Little Brown, 1985:377– 90.
• Grabb WC. The first and second branchial arch syndrome. Plast Reconstr Surg 1965; 36:485–508.
• Poswillo D. Otomandibular deformity: Pathogenesis as a guide to reconstruction. J Maxillofac Surg 1974; 2:64–72.
• Grabb WC. The first and second branchial arch syndrome. Plast Reconstr Surg 1965; 36:485.
• Converse JM, Coccaro PJ, Becker H, Wood-Smith D. On hemifacial microsomia: The first and second branchial arch syndrome. Plast Reconstr Surg 1973; 51:268.
• Mathes SJ. Plastic surgery. 2nd ed. Philadelphia: Sounders, 2006.
• Kaban LB, Moses MH, Mulliken JB. Surgical correction of hemifacial microsomia in the growing child. Plast Reconstr Surg 1988; 82:9-19.
• Mulliken JB, Ferraro NF, Vento AR. A retrospective analysis of growth of the constructed condyle-ramus in children with hemifacial microsomia. Cleft Palate J 1989; 26:312-7.
• Converse JM, Shapiro HH. Treatment of developmental malformations of the jaws. Plast Reconstr Surg (1946) 1952; 10:473-510.
• Converse JM, Shapiro HH. Treatment of developmental malformations of the jaws. Plast Reconstr Surg (1946) 1952;10:316-53.
• Stark RB, Saunders DE. The first branchial syndrome. The oral-mandibular-auricular syndrome. Plast Reconstr Surg Transplant Bull 1962; 29:229-39.