Changes in the zygoma, circumzygomatic sutures, and zygomatic arch in children after trans-sutural distraction osteogenesis
10.3760/cma.j.cn114453-20230510-00101
- VernacularTitle:经缝牵引成骨术后患儿颧骨、环颧骨周缝及颧弓的变化
- Author:
Mengying JIN
1
;
Hongsen BI
;
Hongyu XUE
;
Zhenmin ZHAO
Author Information
1. 北京大学第三医院成形科，北京 100191
- Keywords:
Maxillofacial abnormalities;
Zygoma;
Craniofacial dysostosis;
Zygomatic arch;
Traction;
Circumzygomatic sutures
- From:
Chinese Journal of Plastic Surgery
2023;39(7):737-749
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the changes of the zygoma, circumzygomatic sutures, and zygomatic arch in children after trans-sutural distraction osteogenesis (TSDO).Methods:A retrospective analysis was performed on skull CT data of cleft lip and palate patients who underwent TSDO to correct midfacial hypoplasia between 2005 and 2019 in Peking University Third Hospital. The Mimics 20.0 software was used for three-dimensional(3D) model reconstruction to observe the morphological changes of the zygoma, circumzygomatic sutures, and zygomatic arch at the end of the traction period after TSDO. Measurements were taken and analyzed for the distances from mp point to 3D reference planes, zygoma height, zygoma width 1, zygoma width 2, zygoma thickness, zygoma volume, zygomaticomaxillary suture width, zygomaticotemporal suture width, zygomaticofrontal suture width, zygomatic arch length, and distances from zygomatic arch landmarks (tp point, zy point, and ju point) to the 3D reference planes. All data were divided into cleft and non-cleft sides. GraphPad Prism 9.4.1 software was used to analyze the changes before and after TSDO. Measurement data of normal distribution was expressed by ± s and the comparison between groups before and after traction was analyzed by paired t-test. Measurement data of non-normal distribution was expressed by M(IQR) and the comparison between groups before and after traction was analyzed by paired Wilcoxon test. If P<0.05, the difference was statistically significant. Results:A total of 27 patients were included in the study, including 23 males and 4 females, with a mean age of (11.19±2.35) years (5-15 years). Of these patients, 10 had bilateral cleft lip and palate, and 17 had unilateral cleft lip and palate (9 on the left side and 8 on the right side). The average traction period was (40.26±11.43) days. The midfacial depression of the patients was corrected after TSDO, and the zygoma grew forward, downward, and horizontally. The circumzygomatic sutures shifted forward. The zygomatic arch showed forward and downward growth. The measurements of zygoma showed that the mp point moved forward by (7.82±3.95) mm on the cleft side and 4.26(5.72) mm on the non-cleft side with statistical differences ( P<0.05). The mp point moved slightly downward, and outward after TSDO compared to before surgery, and these differences were statistically significant ( P<0.05). After TSDO, the zygoma height, width, and volume were all increased compared to preoperative levels, and these differences were statistically significant ( P<0.05). The width of the lower part of the zygomatic bone showed the most significant change, increasing by 4.33(5.17) mm on the cleft side and (3.42±2.67) mm on the non-cleft side and these differences were statistically significant ( P<0.05). There was no statistically significant difference in the thickness of the zygoma after TSDO compared to before surgery ( P>0.05). The widths of circumzygomatic sutures were all increased after TSDO compared to before surgery, and these differences were statistically significant ( P<0.05). The width of zygomaticofrontal suture showed the greatest increase and the width of zygomaticomaxillary suture showed the smallest increase. The length of the zygomatic arch increased after TSDO compared to before surgery, with an increase of (4.78±2.71) mm on the cleft side and (2.03±1.48) mm on the non-cleft side, and these differences were statistically significant ( P<0.05). There was no statistically significant difference in the position of the tp point after TSDO compared to before surgery ( P>0.05), while the position of the zy point and the ju point moved significantly forward and downward, and these differences were statistically significant ( P<0.05). In the horizontal direction, there was no statistically significant difference in the position of the zy point and ju point after TSDO compared to before surgery ( P>0.05). Conclusion:After TSDO, the zygoma shows three-dimensional growth with significant increases in height, width, and volume. The position of zygoma moves forward, downward, and outward. The circumzygomatic sutures widen due to the distraction force, and the zygomatic arch grows forward and downward, with an increase in length.
