Ortognatik Cerrahide Üst Çenede Kullanılan Teknikler
Özet
Maksiller deformitelerin sagittal, vertikal ve transvers düzlemlerde düzeltilmesi amacıyla yaygın olarak kullanılan Le Fort 1 osteotomisi, multidisipliner yaklaşımla yürütülen ve hasta tatmini yüksek olan güvenli bir ortognatik cerrahi yöntemdir. Tarihsel süreçte vasküler yapılarının, hipotansif anestezi ve cerrahi tekniklerin geliştirilmesiyle modern haline ulaşan bu prosedürde; piriform rim, burun tabanı ve pterygomaksiller eklem gibi anatomik hatlar deşifre edilerek üst çene mobilize edilmekte ve mini plaklar yardımıyla rijit fiksasyon sağlanmaktadır. Operasyon esnasında burun anatomisini, orta hat konumunu ve üst dudak estetiğini tam bir bütünlük içinde kesintisiz değerlendirebilmek adına submental entübasyon kullanımı giderek popülerleşmektedir. Her ne kadar morbidite ve mortalite oranları düşük olsa da, Le Fort 1 osteotomisinin özellikle hamulus bölgesindeki maksiller arter kaynaklı ciddi hemoraji, infraorbital ve desending palatin sinir hasarlarına bağlı geçici his kayıpları, enfeksiyon, dental uyuşukluklar ile kıkırdak desteğinin yetersizliğinden kaynaklanan burun kanadı genişlemesi veya septum deviasyonu gibi estetik ve fonksiyonel komplikasyon riskleri mevcuttur. Ayrıca, üst çenenin 9 mm'den fazla ilerletildiği durumlarda veya dudak-damak yarığı gibi anatomik düzensizliği bulunan hastalarda postoperatif relaps (nüks) ve non-union gelişme ihtimali belirgin şekilde artmaktadır.
Le Fort 1 osteotomy, widely used for correcting maxillary deformities in sagittal, vertical, and transverse planes, is a safe orthognathic surgery method performed with a multidisciplinary approach and high patient satisfaction. Evolving into its modern form through historical advancements in vascular anatomy, hypotensive anesthesia, and surgical techniques, this procedure mobilizes the maxilla by exposing anatomical lines such as the pyriform rim, nasal floor, and pterygomaxillary junction, achieving rigid fixation with miniplates. Submental intubation is increasingly favored during surgery to allow an uninterrupted, comprehensive evaluation of nasal anatomy, midline position, and upper lip aesthetics. Although morbidity and mortality rates are low, Le Fort 1 osteotomy carries risks of aesthetic and functional complications, including severe hemorrhage from the maxillary artery near the hamulus, temporary numbness due to infraorbital and descending palatine nerve injuries, infections, dental numbness, and nasal alar widening or septal deviation from inadequate cartilage support. Furthermore, in patients with anatomical irregularities like cleft lip and palate, or when maxillary advancement exceeds 9 mm, the likelihood of postoperative relapse and non-union significantly increases.
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