国际口腔医学杂志

国际口腔医学杂志 ›› 2019, Vol. 46 ›› Issue (3): 343-348.doi: 10.7518/gjkq.2019043

• 综述 • 上一篇    下一篇

外科辅助快速上颌扩张的临床研究进展

何映酉,乎森,李继华()   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心四川大学华西口腔医院正颌与关节外科 成都 610041
  • 收稿日期:2018-08-26 修回日期:2019-01-26 出版日期:2019-05-01 发布日期:2019-06-05
  • 通讯作者: 李继华
  • 作者简介:何映酉,学士,Email：925090037@qq.com
  • 基金资助:
    国家自然科学基金(81470720)

Clinical research progress on surgically assisted rapid maxillary expansion

Yingyou He,Sen Hu,Jihua Li()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthognathic and Temporomandibular Joint Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2018-08-26 Revised:2019-01-26 Online:2019-05-01 Published:2019-06-05
  • Contact: Jihua Li
  • Supported by:
    This study was supported by National Natural Science Foundation of China(81470720)

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摘要：

外科辅助快速上颌扩张（SARME）是治疗上颌横向发育不足的常用方法,本文针对SARME术中是否离断翼上颌连接和鼻中隔,术后牵张器的选择进行了文献回顾,并对比了SARME、上颌快速扩张（RME）和上颌骨分段骨切开术（SMO）3种方法在治疗上颌横向发育不足的特点,结果发现术中可不离断翼上颌连接和鼻中隔,减少术中风险,而牙-骨支持式和骨-骨支持式2种牵张器各有优势,SARME、RME和SMO这3种方法的治疗效果与扩张方式各异,需结合临床实际综合考虑进行选择。

关键词: 外科辅助快速上颌扩张, 上颌快速扩张, 上颌骨分段骨切开术, 翼上颌连接, 鼻中隔, 牵张器

Abstract:

Surgically assisted rapid maxillary expansion (SARME) is a common method for treating maxillary transverse deficiency. This article aims to review published studies on the benefits and risks of the intraoperative release of the pterygomaxillary disjunction and the nasal septum and to compare the devices used postoperatively for SARME and the characteristics of three commonly used methods [SARME, rapid maxillary expansion (RME) and segmental maxillary osteotomy (SMO)] for treating maxillary transverse deficiency. Results indicate that the intraoperative release of the pterygomaxillary disjunction and the nasal septum is unnecessary during SARME to reduce intraoperative complications. Tooth- and bone-borne devices are effective and have unique advantages for SARME. Treatments with SARME, RME and SMO yield different therapeutic effects and expansion styles. The selection of a treatment method should be based on clinical requirements.

Key words: surgically assisted rapid maxillary expansion, rapid maxillary expansion, segmental maxillary osteotomy, pterygomaxillary junction, nasal septum, device

中图分类号: 

  • R782.2+3

图 1

不离断翼上颌连接和折断下降上颌骨的改良Le Fort Ⅰ型骨切开术"

图 2

第一前磨牙（A）和第一磨牙（B）区域骨性和牙性的测量指标 NFW：鼻底宽度;PBW：腭骨宽度;IRD：牙根距离;ICD：牙间牙尖距;4：第一前磨牙区域;6：第一磨牙区域[5]。"

图 3

使用CT图像上的解剖标志测量角度Ⅰ和角度Ⅱ A：术前角度Ⅰ（鸡冠-下颌骨联合与鸡冠-鼻中隔的夹角）;B：术后角度Ⅰ;C：术前角度Ⅱ（上颌平面与鼻中隔夹角）;D：术后角度Ⅱ[8]。"

图 4

牙支持式和骨支持式牵张器组成的混合牵张器"

[1] Contar CM, Muller PR, Brunetto AR , et al. Surgical treatment of maxillary transverse deficiency: retrospective study of 14 patients[J]. J Maxillofac Oral Surg, 2009,8(3):249-253.
doi: 10.1007/s12663-009-0061-4
[2] Jensen T, Rodrigo-Domingo M . Surgically assisted rapid maxillary expansion (SARME) with or without intraoperative releasing of the nasal septum[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2017,123(3):e85-e90.
doi: 10.1016/j.oooo.2016.10.003
[3] Angell EC. Treatment of irregularities of the permanent adult teeth[J]. Dent Cosmos, 1860,1:540-545.
[4] Menon S, Manerikar R, Sinha R . Surgical management of transverse maxillary deficiency in adults[J]. J Maxillofac Oral Surg, 2010,9(3):241-246.
doi: 10.1007/s12663-010-0034-7
[5] Zandi M, Miresmaeili A, Heidari A , et al. The necessity of pterygomaxillary disjunction in surgically assisted rapid maxillary expansion: a short-term, double-blind, historical controlled clinical trial[J]. J Craniomaxillofac Surg, 2016,44(9):1181-1186.
doi: 10.1016/j.jcms.2016.04.026
[6] Sygouros A, Motro M, Ugurlu F , et al. Surgically assisted rapid maxillary expansion: cone-beam computed tomography evaluation of different surgical techniques and their effects on the maxillary dentoskeletal complex[J]. Am J Orthod Dentofacial Orthop, 2014,146(6):748-757.
doi: 10.1016/j.ajodo.2014.08.013
[7] Hamedi Sangsari A, Sadr-Eshkevari P, Al-Dam A , et al. Surgically assisted rapid palatomaxillary expansion with or without pterygomaxillary disjunction: a systematic review and Meta-analysis[J]. J Oral Maxillofac Surg, 2016,74(2):338-348.
doi: 10.1016/j.joms.2015.06.161
[8] Reinbacher KE, Wallner J, Pau M , et al. Surgically assisted rapid maxillary expansion: feasibility of not releasing the nasal septum[J]. Int J Oral Maxillofac Surg, 2013,42(3):321-325.
doi: 10.1016/j.ijom.2012.09.021
[9] Altug-Atac AT, Atac MS, Kurt G , et al. Changes in nasal structures following orthopaedic and surgically assisted rapid maxillary expansion[J]. Int J Oral Maxi-llofac Surg, 2010,39(2):129-135.
doi: 10.1016/j.ijom.2009.11.013
[10] Zandi M, Miresmaeili A, Heidari A . Short-term skeletal and dental changes following bone-borne versus tooth-borne surgically assisted rapid maxillary expansion: a randomized clinical trial study[J]. J Craniomaxillofac Surg, 2014,42(7):1190-1195.
doi: 10.1016/j.jcms.2014.02.007
[11] Kayalar E, Schauseil M, Kuvat SV , et al. Comparison of tooth-borne and hybrid devices in surgically assisted rapid maxillary expansion: a randomized clinical cone-beam computed tomography study[J]. J Craniomaxillofac Surg, 2016,44(3):285-293.
doi: 10.1016/j.jcms.2015.12.001
[12] Hamedi-Sangsari A, Chinipardaz Z, Carrasco L . Following surgically assisted rapid palatal expansion, do tooth-borne or bone-borne appliances provide more skeletal expansion and dental expansion[J]. J Oral Maxillofac Surg, 2017,75(10):2211-2222.
doi: 10.1016/j.joms.2017.04.019
[13] Kunz F, Linz C, Baunach G , et al. Expansion patterns in surgically assisted rapid maxillary expansion: transpalatal distractor versus hyrax appliance[J]. J Orofac Orthop, 2016,77(5):357-365.
doi: 10.1007/s00056-016-0043-3
[14] Sokucu O, Kosger HH, Bicakci AA , et al. Stability in dental changes in RME and SARME: a 2-year follow-up[J]. Angle Orthod, 2009,79(2):207-213.
doi: 10.2319/031808-155.1
[15] Kurt G, Altug-Ataç AT, Ataç MS , et al. Stability of surgically assisted rapid maxillary expansion and orthopedic maxillary expansion after 3 years’ follow-up[J]. Angle Orthod, 2010,80(4):425-431.
doi: 10.2319/052309-292.1
[16] Giannini L, Maspero C, Galbiati G , et al. Comparison of the palatal expansion obtained via the use of the rapid maxillary expander compared with surgically assisted rapid maxillary expansion[J]. Minerva Stomatol, 2016,65(2):72-80.
[17] Samra DA, Hadad R . Skeletal Age-related changes of midpalatal suture densities in skeletal maxillary constriction patients: CBCT study[J]. J Contemp Dent Pract, 2018,19(10):1260-1266.
doi: 10.5005/jp-journals-10024
[18] Yao W, Bekmezian S, Hardy D , et al. Cone-beam computed tomographic comparison of surgically assisted rapid palatal expansion and multipiece Le Fort Ⅰ osteotomy[J]. J Oral Maxillofac Surg, 2015,73(3):499-508.
doi: 10.1016/j.joms.2014.08.024
[19] Seeberger R, Gander E, Hoffmann J , et al. Surgical management of cross-bites in orthognathic surgery: surgically assisted rapid maxillary expansion (SARME) versus two-piece maxilla[J]. J Craniomaxillofac Surg, 2015,43(7):1109-1112.
doi: 10.1016/j.jcms.2015.05.012
[20] Starch-Jensen T, Blæhr TL . Transverse expansion and stability after segmental Le Fort Ⅰ osteotomy versus surgically assisted rapid maxillary expansion: a systematic review[J]. J Oral Maxillofac Res, 2016,7(4):e1.
[21] Lee HW, Kim SJ, Kwon YD . Salvage rapid maxillary expansion for the relapse of maxillary transverse expansion after Le Fort Ⅰ with parasagittal osteotomy[J]. J Korean Assoc Oral Maxillofac Surg, 2015,41(2):97-101.
doi: 10.5125/jkaoms.2015.41.2.97
[22] Leyder P, Altounian G, Chardain J , et al. Adjustable selective maxillary expansion combined with maxillomandibular surgery: a case report[J]. Int Orthod, 2015,13(3):320-331.
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