我国正颌外科的新进展

1999年9月6～9日在大连召开了全国第三次正颌外科学术会议。这次学术会议充分地反映了4年来我国正颌外科取得的新成就、新进展,并就我国正颌外科普及与发展的一些重要问题进行了深入探讨。它将对我国正颌外科的发展具有深远的影响。一、简要历史回顾在国际现代正颌外科的发展进程中,几代学者经历了近百年的艰苦探索,到本世纪60年代中期,正颌外科成为口腔颌面外科的热点。此后,在每期的颌面外科专业杂志都有很多论文发表,每次的专业学术会议都有新进展的报告,世界各地每年都有正颌外科的专题讲座。短短的十余年间,新技术迅速传播,这一学科已…     

正颌外科与颌骨牵引成骨

正颌外科简要历史回顾 自从1848年Hullihen完成了人类历史上第一例牙颌面畸形矫治以来,正颌外科的发展已经经历了超过一个半世纪的岁月.但是在正颌外科发展初期的一百年间,仅有零星的有关牙颌面畸形矫治的报告散在于医学文献中,而且重复着偶尔的成功与大量的失败.     

正颌外科与颌骨牵引成骨

<正> 1 正颌外科简要历史回顾自从1848年美国学者 Hullihen 完成了人类历史上第一例牙颌面畸形矫治以来,正颌外科的发展已经经历了超过一个半世纪的岁月。但是在正颌外科发展初期的100年间,仅有零星的有关牙颌面畸形矫治的报告散在于医学文献中。而且重复着偶尔的成功与大量的失败。20世纪50～70年代,随着人类社会的进步,牙     

双颌畸形的正颌外科矫治

复杂双颌畸形的治疗是正颌外科治疗的难点. 近年来正颌外科手术、正畸技术的成熟与发展,特别是数字化外科在正颌领域的成功应用,为复杂牙颌面畸形的诊断、治疗提供了更为精确的处理手段,使得患者的治疗效果日趋完善. 广东省口腔医院口腔颌面外科每年收治100多例复杂的双颌畸形患者,对双颌畸形的正颌外科矫治积累了较为丰富的经验. 本文就双颌畸形正颌外科矫治的有关问题进行阐述.     

正颌外科术后畸形复发的生物学因素及其防治

正颌外科术后畸形复发的生物学因素及其防治王友山杨学文东耀峻自１９８５年全国正颌外科学术会议以来，正颌外科在国内得到了迅速发展。随着正颌手术的广泛开展，术后畸形复发这一问题越来越引起人们的重视，并成为正颌外科面临的最大挑战［１］。本文就正颌外科术后畸形...     

正颌外科术后咀嚼肌功能的适应性变化

正颌外科术后咀嚼肌功能的适应性变化宋一平近年来外科正颌外科在我国已较为广泛的开展，并且发展很快。对于面型异常的严重骨性，结合应用外科和正畸的方法进行矫治，可以使患者在容貌上获得良好的外形，但正颌外科手术瞬间对口颌系统进行了如此巨大的改变，势必引起的一...     

华西口腔医院正颌外科专科医师规范化培训改革探索

专科医师培训是我国临床医师培训的一个重要内容。正颌外科是口腔颌面外科的亚专业之一,也是口腔颌面外科专科医师培训中不可或缺的一部分。目前我国的正颌外科专科医师的数量匮乏,在正颌外科专科医师培训方面存在各种困难和不足。本文通过分析目前国内正颌外科专科医师培训的现状和困难,介绍我们在建立正颌外科专科医师规范化培训体系方面的尝试与经验,并为最终培养出规范、标准、具有完整专科知识体系的正颌外科专科人才提供有价值的参考。     

中华医学会四川分会、华西医科大学举办正颌外科讲习班

正颌外科是近十多年发展起来的新兴学科。为了介绍推广有关正颌外科的新理论、新技术,使这一学科在我国得到更快的发展,更好地为病员服务,中华医学会四川分会与华西医科大学口腔医学院于1985年11月25日至30日在成都华西医大附属口腔医院联合举办了正颌外科讲习班。来     

对外科正牙术的历史回顾与展望

回顾外科正牙术 (牙外科正畸术 )历史 ,由于时代变迁和社会之不断进步 ,常规牙正畸治疗和正颌手术之快速发展 ,外科正牙的部分手术方法可能仅适合当时情况而今天已不再适用。在我国目前社会已经开放 ,但经济情况相对滞后而且地区发展不平衡的大环境下 ,作者认为外科正牙术仍有广泛适应证 ,而且此方法仍需改进和发展。了解过去的理论基础与发展过程 ,对于开拓手术思路、改进手术方法是有益的。　　 1　历史回顾Ｃｕｎｎｉｎｇｈａｎ (1893)最早报告将 1颗严重舌向错位的上颌侧切牙外科正畸方法复位 ,他认为用这种方法虽然牙髓可能失活 ,但仍…     

我国口腔颌面外科专业领域的又一部力作——评《正颌外科手术学》出版发行

正颌外科是在70年代我国的科学春天莅临后口腔颌面外科领域里兴起了颅颌外科、正颌外科、显微外科、植体外科中发展较为迅速,成果较为丰硕的一个新颖临床分支专业。它不仅为各类牙颌面畸形患者的矫治提供了手段,而且它的矫治设计原则、手术方法技巧也融入了颌面创伤治疗、...     

颞颌关节强直续发OSAS患者术前后睡眠变化

作者对１０例颞颌关节强直续发ＯＳＡＳ患者有后的睡眠检测结果比较分析，指出术后患者睡眠呼吸暂停指数、睡眠时血氧饱和水平、氧饱度和下降至９０％以下次数均得到改善，同时睡眠质量获得提高，证明颞颌关节重建与正颌技术结合的方法是治疗颞颌关节强直续发ＯＳＡＳ的有效措施。     

正颌外科术后髁突移位的病因与治疗研究进展

不同程度的髁突移位是正颌外科术后常见并发症。术后髁突移位可能是由于重新定位的颌骨固定不充分、固定期间髁突表面再吸收及髁突在颞下颌关节内缺乏被动就位等多方面因素所致。这些问题可能会使再次治疗的难度变大,患者心理负担增加,也可能会影响患者的依从性。因此,正颌外科术后髁突移位的治疗与预防是近年来学者们重点研究的方向。文章就正颌外科术后髁突移位的病因、治疗与预防方法研究进展做一综述。     

Stability of orthognathic surgery and distraction osteogenesis: options and alternatives

Relapse in orthognathic surgery is multifactorial and can be attributed to posttreatment growth, condylar changes, lack of rigid fixation, and muscle pull and function. Consideration of these factors can aide the surgeon in the decision-making process with regards to treatment options and alternatives. This article reviews the stability of various orthognathic movements using traditional osteotomies and fixation, and compares them to what is currently in the literature regarding distraction osteogenesis.     

Complications and failures in orthognathic surgery

This paper reviews the literature about the most relevant complications in daily orthognathic surgery. Although orthognathic surgery has proven to be relatively safe, patients who undergo such maxillofacial orthopaedic surgery must be aware of the side effects of this combined treatment. Immediate life-threatening complications are very rare. They can in most cases be avoided by good anaesthetic and surgical techniques and adequate postoperative care. The most frequently encountered perioperative problem in maxillary surgery is excessive blood loss, whilst subjective neurosensory disturbance is the most frequent complication in mandibular surgery. Good co-operation between orthodontist and surgeon is essential to prevent most immediate and late postoperative problems and nearly all unsatisfactory results.     

Hierarchy of surgical stability in orthognathic surgery: overview of systematic reviews

The purpose was to perform an overview of systematic reviews in order to create a hierarchical scale of stability in orthognathic surgery with the aid of the highest level of scientific evidence. The systematic search was conducted in the PubMed, Embase, and Cochrane Library databases. The grey literature was investigated in Google Scholar and a manual search was done of the references lists of included studies. Fifteen studies were included in the final sample, of which eight were systematic reviews and seven were meta-analyses. These were assessed for methodological quality using the AMSTAR 2 tool and all were considered to be of medium to high methodological quality. The clinical studies included in the 15 reviews and meta-analyses were classified by the review authors as having a moderate to high potential for risk of bias. The hierarchical pyramid of stability in orthognathic surgery was established, with two surgical procedures considered highly unstable: (1) maxillary expansion with semi-rigid internal fixation evaluated at the dental level in the posterior region, and (2) clockwise rotation of the mandible with rigid internal fixation of bicortical screws in the sagittal direction.     

A hypothesis on the desired postoperative position of the condyle in orthognathic surgery: a review

It is very important to clarify the relationship between a dentofacial structure and a temporomandibular joint (TMJ) structure in orthognathic surgery. Recently, it was reported that the skeletal and occlusal patterns were associated with the TMJ morphology, including the disk position. In orthognathic surgery, some surgeons state that alterations in the condylar position from surgery can lead to malocclusion associated with the risk of early relapse, and also favor the development of temporomandibular disorders. For these reasons, several positioning devices have been proposed and applied, but now there is no scientific evidence to support the use of condylar positioning devices. There are some reasons why scientific evidence cannot be obtained; however, it also includes the question of whether the preoperative position of the condyle is the desired postoperative position. The purpose of this study was to verify the desired condylar position in orthognathic surgery, based on literature on the postoperative condylar position in orthognathic surgery. From the studies reviewed, it was suggested that the preoperative position of the condyle was not the desired postoperative position in orthognathic surgery.     

基于CAD/CAM技术的钛合金制品在正颌外科手术中应用研究进展

计算机辅助设计与计算机辅助制作（computer aided design and computer aided manufacturing，CAD/CAM）技术发展迅速，在医学领域尤其是外科领域已被广泛应用。正颌外科是外科学的重要组成部分，其对于治疗的精度与材料的质量要求严格，而基于CAD/CAM技术的钛合金制品（如钛制定位导板、钛制钻孔导板及钛制截骨导板等）具有良好的性能，在该领域会有很好的应用前景。文章就基于CAD/CAM技术的钛合金制品在正颌外科手术中应用研究进展做一综述。     

Relapse after orthodontics and orthognathic surgery

A combined orthodontic and surgical approach is often the treatment of choice for the correction of severe dentofacial deformities. Numerous orthognathic surgical procedures have been developed for this treatment. It is clear that certain orthognathic surgical procedures have a tendency to relapse; many studies have been conducted in an attempt to create a pattern of predictability and a prognosis of stability. This article reviews the literature briefly and presents four cases in which the combined surgical and orthodontic approach produced less than satisfactory results. The small number of patients does not permit statistical evaluation or firm conclusions regarding the occurrence and the etiology of relapse in general. This article underlines the importance of long-term follow-up for all patients treated with a combination of orthodontics and orthognathic surgery.     

Temporomandibular joint internal derangements in an orthognathic surgery population.

Of a selected group of 39 patients referred for orthognathic surgery, 38 were found to have some stage of internal derangement of the temporomandibular joint prior to surgery, a much higher incidence than previously reported in either symptomatic patients or asymptomatic individuals. Fifteen of 30 patients with follow-up greater than 12 months developed a new arthrosis after orthognathic surgery. All arthroses occurred in previously deranged joints. None of these patients has required joint surgery, but three have experienced pain. Internal derangement may be a contributing factor in the development of dentofacial deformities, and new loading of deranged joints after orthognathic surgery may be a cause of a new arthrosis and skeletal relapse.     

国际正颌外科发展回顾与展望

作为颌面外科最常见的病种之一的牙颌面畸形是指因颌骨生长发育异常所引起的颌骨体积、形态,以及上、下颌骨之间及其与颅面其他骨骼之间的关系异常和随之伴发的咬合关系及口颌系统功能异常,外观常常表现为硬组织及软组织的形态异常。治疗这种疾病的正颌手术的发展经历了漫长的过程,凝聚了众多学者的心血和努力。本文分阶段简要回顾了正颌外科的发展历史,对于更好地了解这一专业的内涵及前景具有一定意义。