LE FORT I OSTEOTOMİSİNDE İKİ PLAK İLE MAKSİLLER FİKSASYON YÖNTEMİ :TEKNİK RAPOR VE VAKA SUNUMU

Yıl 2020, , 230 - 236, 30.12.2020

Esra Beyler Nur Altıparmak

https://doi.org/10.25279/sak.515243

Öz

Restoring facial esthetics and occlusion while maintaining long term stability are the goals of orthognathic surgery. Le Fort I osteotomy is frequently used for the correction of dentofacial deformities and is accepted as a relatively stable procedure. Many factors affecting the stability of the mobilized maxilla have been reported. Among these, the use of a stable internal fixation method is of primary importance to postoperative stability. Most oral and maxillofacial surgeons prefer bilaterally applying titanium miniplates in both the anterior apertura piriformis region and the posterior zygomaticomaxillary buttress region to achieve the rigid fixation of the maxillary segment following Le Fort I osteotomy. In the literature, there is currently a lack of agreement on the number of plates required to adequately secure the mobilized maxilla to prevent postoperative relapse. Reducing the number of miniplates allows surgeons to reduce any potential complications, operation time, and costs. In this case report, a patient with maxillary retrognathia and mandibular prognathia, manifesting dental Class III characteristics who underwent one piece Le Fort I osteotomy at Baskent University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery was presented. Under general anesthesia one piece Le Fort I osteotomy was performed. Following down fracture, mobilization of the maxillary segment was completed and 10 mm horizontal advancement movement was achieved. Surgical rigid fixation was performed under intermaxillary fixation with surgical splints. Maxillary fixation was completed with two pre-bent titanium Le Fort I plate placed bilaterally at the piriform apertura with no zygomaticomaxillary buttress fixation. Prior to extubation, intermaxillary fixation and surgical splints were released. Intermaxillary elastics were used six to eight weeks following surgery in addition to a soft, no-chew diet. The patient received both preoperative and postoperative orthodontic treatment. Digital lateral cephalometric radiographs, which were taken one week before orthognatic surgery (T1), one week postoperatively (T2), and nine months postoperatively (T3), were used to analyze skeletal movement and stability of the maxilla. Lateral cephalometric measurements were performed digitally using a computer-assisted software program. Linear and angular measurements of sagittal and vertical maxillary positions was calculated. A horizontal reference plane (HR) +7° to the SN plane at the S point and a vertical reference plane (VR) 90° to the horizontal plane at the Sella point were used in the analyses. After completion of growth and development, the SN plane remains in the same position, giving us the opportunity to measure skeletal movement with these horizontal and vertical reference planes. The difference in the A point-HR distances between the pre and postoperative radiographs indicates the horizontal movement of the maxilla, whereas the difference in the A point-VR distances indicates the vertical movement of the maxilla. The major criteria for maxillary skeletal relapse was the change in the distance from the A point to the horizontal and vertical reference planes. Significant immediate postsurgical changes were found in early postoperative lateral cephalometric radiography (T2). In 9 month follow-up lateral cephalometric measurements (T3) all landmarks in the horizontal and vertical plane showed skeletal stability. The relapse amount in maxillary movement was less than 1 mm in both horizontal and vertical planes. According to the postoperative lateral cephalometric measurements, the two plate anterior fixation method in the one piece Le Fort I ostetomy showed satisfactory results in terms of skeletal stability.

Anahtar Kelimeler

Maksiller ilerletme, Le fort I osteotomisi, L plak

Kaynakça

• 'Teuscher, V. S.H. (1982). Stability of Le Fort I osteotomy in class III cases with retropositioned maxillae. J Maxillofac Surg., 10(2), 80-83. 'Fish, L.C., L.M. Wolford, and B.N. Epker. (1978). Surgical-orthodontic correction of vertical maxillary excess. American Journal of Orthodontics and Dentofacial Orthopedics, 73(3): p. 241-257. 'Politi, M. (2002), Stability of maxillary advancement for correction of skeletal Class III malocclusion after combined maxillary and mandibular procedures: preliminary results of an active control equivalence trial for semirigid and rigid fixation of the maxilla. The International journal of adult orthodontics and orthognathic surgery, 17(2): 98-110. 'Costa, F., M. Robiony, and M. Politi.(1999). Stability of Le Fort I osteotomy in maxillary advancement: review of the literature. The International journal of adult orthodontics and orthognathic surgery. 14(3): 207-213. 'Bishara, S.E., et al. (1998). Stability of the LeFort I one-piece maxillary osteotomy. American Journal of Orthodontics and Dentofacial Orthopedics, 94(3): 184-200. 'Luyk, N.H. and R.P. Ward-Booth. (1985). The stability of Le Fort I advancement osteotomies using bone plates without bone grafts. Journal of maxillofacial surgery, 13: 250-253. 'Posnick, J.C. and M. Taylor. (1994) Skeletal stability and relapse patterns after Le Fort I osteotomy using miniplate fixation in patients with isolated cleft palate. Plastic and reconstructive surgery, 94(1): 51-60. 'Hennes, J., et al. (1988). Stability of simultaneous mobilization of the maxilla and mandible utilizing internal rigid fixation. The International journal of adult orthodontics and orthognathic surgery, 3(3): 127-141. 'Quejada, J. (1987). Skeletal stability after inferior maxillary repositioning. The International journal of adult orthodontics and orthognathic surgery. 2(2): 67. 'Bothur, S., J.E. Blomqvist, and S. Isaksson. (1998), Stability of Le Fort I osteotomy with advancement: a comparison of single maxillary surgery and a two-jaw procedure. Journal of oral and maxillofacial surgery, 56(9):1029-1033. 'Rotter, B.E. and D.L. Zeitler (1999), Stability of the Le Fort I maxillary osteotomy after rigid internal fixation. Journal of oral and maxillofacial surgery, 57(9): 1080-1088. 'Yoon, H.-J., J. Rebellato, and E.E. Keller (2005), Stability of the Le Fort I osteotomy with anterior internal fixation alone: a case series. Journal of oral and maxillofacial surgery, 63(5): 629-634. 'Proffit WR, R. P., White, D.M. (2003). Sarver. Contemporary Treatment of Dentofacial Deformity. St.Louis, Missouri. The Mosby Co.