手术优先正颌正畸联合矫治成人骨性牙颌面畸形的效果  

Clinical outcomes of combined orthognathic and orthodontic treatment of adult dentomaxillofacial deformity with surgery-first approach

作　　者：胡超 吴国平[1] 李春龙[1] 上官文松 张文文[1] 王树 卢通 赵杨[1] 希吉日 乔祥 蒋巧凤 Hu Chao;Wu Guoping;Li Chunlong;Shangguan Wensong;Zhang Wenwen;Wang Shu;Lu Tong;Zhao Yang;Xi Jiri;Qiao Xiang;Jiang Qiaofeng(Department of Plastic Surgery,the Affiliated Friendship Plastic Surgical Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属友谊整形外科医院整形外科,210029

出　　处：《中华医学美学美容杂志》2020年第6期520-524,共5页Chinese Journal of Medical Aesthetics and Cosmetology

摘　　要：目的探讨手术优先正颌正畸联合矫治成人骨性牙颌面畸形的可行性及疗效。方法2012年1月至2019年12月,南京医科大学附属友谊整形外科医院整形外科用手术优先方案矫治217例(男97例,女120例,年龄18~38岁,平均23.6岁)骨性牙颌面畸形患者。术前拍摄头颅定位侧位片及头颅三维CT,进行头影测量分析,根据畸形情况分别用上颌Le FortⅠ型截骨、双侧下颌升支矢状劈开截骨、上颌前牙根尖下截骨、下颌前牙根尖下截骨、颏部截骨等手术矫正颌骨畸形,术后2周进行正畸治疗。结果术中下颌骨折5例(2.3%)术中行坚强内固定后愈合良好,术后下唇麻木124例(57.1%),98例在术后3个月症状消失,26例麻木范围减小,症状缓解。9例(4.1%)患者术后出现暂时开[牙合]现象,经颌间牵引1个月后开[牙合]消失。所有患者均无骨坏死、感染,伤口愈合不良等其他并发症出现;所有患者手术后均完成正畸治疗,治疗周期6~15个月(平均9.6个月)。随访6~36个月,所有患者均获得较为满意的面形和咬合关系,效果满意。结论手术优先正颌正畸联合治疗方案矫治治成人骨性牙颌面畸形可行,能更快获得面部轮廓和咬合功能改善,降低正畸治疗难度、缩短治疗时间,临床疗效满意,患者更易接受,是理想的治疗方法。Objective To investigate the clinical feasibility and efficacy of combined orthognathic and orthodontic treatment of dentomaxillofacial deformity in adults with surgery-first approach.Methods A retrospective analysis was performed on 217 patients with dentomaxillofacial deformity were treated with surgery-first approach from January 2012 to December 2019.Preoperative cephalometric analysis was performed by taking lateral cephalometric images and three-dimensional CT.According to the deformity,Le Fort I maxillary osteotomy,bilateral sagittal split ramus osteotomy,segmental Le Fort I maxillary osteotomy,mandibular subapical osteotomy,and genioplasty were performed to correct the jaw deformity.Postoperative orthodontic treatment was started after a healing period of 2 weeks after the operation.Results Intraoperative mandibular fracture(5 cases,2.3%),and healed well after intraoperative rigid internal fixation.lower lip numbness(124 cases,57.1%),the symptoms disappeared in 98 cases and reduced in 26 cases within 3 months,temporary open-bite was observed in 9 cases(4.1%),and diminished by inter-maxillary elastic distraction one month after operation.None of the patients had osteonecrosis,infection,poor wound healing and other complications.All patients completed orthodontic treatment after surgery,and the treatment duration was 6-15 months(average 9.6 months).During the 6-36 months of follow-up,a good facial profile and ideal occlusion were achieved in all patients.Conclusions The surgery-first approach,combined orthognathic and orthodontic therapies,is feasible to treat dentomaxillofacial deformity in adults.With the advantages of earlier improvements in patient facial aesthetics and dental function,the reduction in difficulty and treatment duration of orthodontic management,and increasing patient acceptance.It is regarded as an ideal and valuable alternative for this potentially patients.

关 键 词：牙颌面畸形 手术优先 正颌外科 错[牙合]畸形 截骨术 

分 类 号：R782.2[医药卫生—口腔医学]