不同正颌外科方案对骨性Ⅲ类伴前牙开(恰) 垂直向稳定性的影响

目的 比较不同正颌外科手术方案对骨性Ⅲ类错伴前牙开术后垂直向稳定性的影响.方法 收集入院接受手术的骨性Ⅲ类错伴前牙开畸形患者122例,分别采用双侧下颌升支矢状劈开(BSSRO)(50例)、下颌升支垂直骨劈开(IVRO)(30例)、BSSRO+Le FortⅠ(22例)、IVRO+Le FortⅠ(20例)作为手术方案,并且除IVRO方案外其他所有方案病例均接受钛板颌骨内坚固内固定术.术后正畸完成时及完成后6、24个月时随访接受临床检查与头影测量分析评估垂直向复发情况,观察指标包括覆、下颌平面角、颌间夹角.结果 01)BSSRO+Le FortⅠ与IVRO+Le FortⅠ组覆显著减小的比率在6、24个月都少于BSSRO与IVRO组.2)BSSRO+Le FortⅠ组与IVRO+Le FortⅠ组下颌平面角显著增加的比率在6、24个月都少于BSSRO与IVRO组.3)6个月时BSSRO+Le FortⅠ组与IVRO+Le FortⅠ组颌间夹角显著增加的比率少于BSSRO组与IVRO组,而24个月时无统计学差异.结论 双颌外科(BSSRO+Le FortⅠ与IVRO+Le FortⅠ)均比单颌外科(BSSRO与IVRO)能更加有效地减少垂直向复发的数量和幅度.     

儿童和成人深覆牙合牙合颅颌形态的横断面研究

目的对儿童和成人深覆牙合患者的颅颌面形态进行横断面研究,分析其生长发育中颅颌形态变化的趋势,探讨成人深覆牙合患者的颅颌面形态特征。方法随机抽取Ⅲ度儿童深覆牙合患者159例（平均年龄12.47岁）,成人深覆牙合患者81例（平均年龄21.76岁）,个别正常对照组51例（平均年龄18.41岁）。采用Winceph 7.0软件对3组X线头影测量项目进行测量,采用SPSS 12.0软件进行统计学分析。结果儿童深覆牙合患者在上前面高、下前面高、上颌第一磨牙相对于上颌前部的位置、上颌骨长度、上下颌骨-平面距、上颌磨牙-腭平面距、下颌切牙-下颌平面距、上下齿槽座点平面-下颌平面角、下颌角、下颌切牙距、覆盖、下颌平面-前颅底平面角、下颌磨牙-下颌平面距、后面高、上颌切牙距、下颌体长度、下颌升支高度、平面-前颅底平面角、上颌中切牙-前颅底平面角与成人深覆牙合患者间差异有统计学意义。成人深覆牙合患者在下颌-前颅底平面角、上下颌骨-前颅底平面角、颌凸角、上下颌骨矢状向不调指数、上下颌骨垂直向不调指数、上下颌骨-平面距、上下齿槽座点平面-下颌平面角、下颌角、覆盖、下颌平面-前颅底平面角、上颌后部位置、下颌磨牙-下颌平面距、上颌中切牙-前颅底平面角、下颌体长度、下颌升支高度、后颅底长度、平面-前颅底平面角、后面高与正常个体间差异有统计学意义。结论深覆牙合患者随着年龄的增长,颅、颌、、面部仍表现有一定的生长潜力,但是患者颌骨矢状关系并无改善。成人深覆牙合患者颌面部特征表现为垂直向、矢状向关系显著不调。     

不同垂直骨面型个别正常下颌骨形态及牙列特征研究

目的 比较不同垂直骨面型个别正常牙合的差异,为临床上不同垂直骨面型人群正畸治疗目标的确定提供指导。方法 采集30例个别正常牙合成人为研究对象,根据下颌平面角FH/MP的大小分为高角组（8例）、均角组（12例）和低角组（10例）。使用DICOM数据导入Invivo5软件测量∠L1/MP、∠L6/MP、L6牙长轴交角、牙合平面角、Balkwill角、Bonwill三角高与底之比。结果 高角组和均角组∠L6/MP小于低角组,牙合平面角大于低角组,差异具有统计学意义（P<0.05）;其余测量项目组间差异均无统计学意义（P>0.05）。结论 高角组、均角组个别正常牙合人群牙合平面较低角组前倾,下颌第一磨牙牙长轴在近远中方向上较低角组直立,而高角组与均角组之间无明显差异。在正畸治疗中,与高角及均角患者相比,低角患者的牙合平面相对于眼耳平面位置更接近水平,下颌磨牙位置相对于下颌平面更向近中倾斜。     

髁突良性病变继发偏颌畸形手术治疗顺序研究

目的    探讨髁突良性病变继发偏颌畸形的最佳手术治疗顺序。方法    收集2014年5—9月在上海交通大学医学院附属第九人民医院口腔外科收治的6例单侧髁突良性病变继发偏颌畸形患者的CT资料,采用ProPlan CMF 1.4软件分别模拟2种手术顺序：（1）先行上颌骨Le FortⅠ型截骨,再行髁突高位切除+下颌骨矢状劈开截骨术（BSSRO）;（2）先行髁突高位切除+BSSRO后,再行上颌骨Le FortⅠ型截骨。比较两种不同手术顺序中间牙合板的厚度及宽度。结果    6例患者中,5例露齿正常（露齿2.0～3.0 mm）的患者,手术顺序（2）比（1）的中间牙合板厚度和宽度显著减小,其中厚度平均薄3.99 mm,宽度平均窄2.47 mm,差异均有统计学意义（均P＜0.05）;1例露齿过多 （露齿5.5 mm） 的患者,上颌骨需要整体压缩抬高,手术顺序（1）比（2）的中间牙合板体积小,厚度薄3.09 mm,宽度窄1.99 mm。结论    髁突良性病变继发偏颌畸形的关节颌骨同期手术中,在露齿正常的情况下,采用先髁突高位切除+BSSRO再行上颌骨Le FortⅠ型截骨的手术顺序比先行上颌骨Le FortⅠ型截骨再髁突高位切除+BSSRO的手术顺序更准确。     

骨性Ⅱ类错牙合女性患者上颌磨牙近远中倾斜度的CBCT分析

目的:分析骨性Ⅱ类错牙合女性患者上颌磨牙近远中倾斜情况,以期为临床治疗提供参考。方法:选取骨性Ⅱ类错牙合30例及个别正常牙合10例治疗前CBCT数据,以眼耳平面、腭平面及牙合平面测量上颌磨牙倾斜度,并将患者测量项目与个别正常牙合数据进行单样本t检验。将骨性Ⅱ类高角、均角和低角间进行单因素方差分析,并把不同垂直骨面型间的测量项目与下颌平面角及牙合平面角进行Pearson相关性分析。结果:在FH平面、腭平面及牙合平面为参考平面时,骨性Ⅱ类U6较个别正常牙合更加远中倾斜。以腭平面及FH平面为参考时,骨性Ⅱ类低角组到高角组,U6有远中倾斜趋势。以牙合平面为参考时,U7在高角组到低角组有远中倾斜趋势。结论:为代偿上下颌骨矢状向关系不调,骨性Ⅱ类错牙合U6有远中倾斜。骨性Ⅱ类U6随下颌平面角的增加代偿性远中倾斜,但U7远中倾斜趋势不明显。无论何种骨性Ⅱ垂直骨面型,U6代偿性倾斜移动以维持咬合力沿牙齿长轴传递。     

青少年期不同垂直骨面型个别正常下颌骨形态及牙列特征研究

目的 探究不同垂直骨面型的青少年个别正常下颌骨形态及牙列特征,了解其正常范围及变化规律,为青少年期正畸患者的矫治提供一定参考。方法 选取42例个别正常的青少年（12~18岁）为研究对象,根据下颌平面角（FH/MP）分为低角组（7例）,均角组（23例）,高角组（12例）。通过Invivo 5软件分别测量其平面角、L6牙长轴交角、∠L1/MP、∠L6/MP、Balkwill角、Bonwill三角高与底之比,以了解其颅颌面特征。结果 低角组的平面和L6牙长轴交角小于均角组和高角组;均角组的∠L1/MP大于高角组;高角组的∠L6/MP小于低角组和均角组,差异均具有统计学意义（P<0.05）;其余测量项目,差异无统计学意义（P>0.05）。结论 青少年不同垂直骨面型个别正常下颌骨形态及牙列特征间存在差异。低角组平面相对于均角组和高角组更加平行于眶耳平面;低角组下颌第一磨牙在颊舌方向上相对于另外两组直立,而在近远中向上,其牙长轴相对于下颌体近中倾斜更加明显。此测量结果与成年人群个别正常之间存在差异,提示随着年龄增长与颅颌部发育变化,与之相适应的功能也将发生改变。     

术前正畸对骨性Ⅲ类错颌患者颞下颌关节影响的锥形束CT研究

目的 探讨术前正畸对行正畸-正颌联合治疗的骨性Ⅲ类错颌患者颞下颌关节（TMJ）的影响。方法 选取24例行正畸-正颌联合治疗的骨性Ⅲ类错颌患者,分别在术前正畸完成前后检查并记录关节症状,并行锥形束CT（CBCT）扫描,在三维方向测量髁突各径值（d）、髁突高度（h）、不同角度下关节间隙（L）、双侧髁突间距（R）及各髁突角度值,比较和分析不同时期TMJ症状及骨性结构的变化情况。结果 术前正畸前后关节症状无明显改变;颞下颌关节骨性结构在三维方向上的各测量指标均无显著变化（P>0.05）。结论 在正畸-正颌联合治疗过程中,术前正畸不会对患者TMJ产生明显影响。     

骨性Ⅲ类偏颌患者髁突与(牙合)平面特征的CBCT研究

目的 利用锥形束CT(CBCT)测量分析骨性Ⅲ类偏颌患者髁突及(牙合)平面特征。方法 选取符合纳入标准的骨性Ⅲ类成年患者40例,所有个体按照颏下点偏离正中矢状面距离进行分组,分别测量各组左右两侧(牙合)平面角、髁突位置及形态,并对数据进行统计学分析。结果 骨性Ⅲ类偏颌患者的偏侧与对侧相比,(牙合)平面角、关节前间隙、关节上间隙、关节外间隙及髁突内外径差异有统计学意义(P<0.05),偏侧关节后位所占比例较大,下颌骨偏移量与偏侧髁突前间隙及对侧(牙合)平面角均呈正相关(P<0.01)。骨性Ⅲ类非偏颌患者的左右两侧(牙合)平面角、髁突位置及形态指标之间差异均无统计学意义(P>0.05),关节以前位、中位为主。结论 骨性Ⅲ类偏颌患者左右两侧(牙合)平面角、髁突位置及形态不对称,偏侧(牙合)平面角及髁突内外径较小,髁突向后下内方移位,且偏颌程度与(牙合)平面角及髁突位置之间存在相关性。     

不同程度深覆牙合患者颈椎异常的研究

目的:研究不同程度深覆牙合患者颈椎异常的发病率及其与颅面形态间的关系。方法:根据深覆牙合程度将124例深覆牙合患者分成3组作为实验组,48例正常覆牙合患者作为对照组,检查颈椎融合、后弓发育缺陷的发病率,对头颅侧位片各测量指标与颈椎异常的关系进行相关性分析。结果:4组患者颈椎正常、颈椎融合、2个以上异常的发生率有统计学差异;4组测量值中PP-MP、SN-MP、SNB、ANB、A-N-Pog、ILs-PP、覆牙合、覆盖值有统计学差异;其中PP-MP、ANB、A-N-Pog、ILs-PP、覆牙合、覆盖与颈椎异常存在相关性。结论:深覆牙合越重的患者其颈椎融合的发生率越高且2个以上变异的发生率也越高;下颌位置、上下颌间高度、覆牙合和覆盖与颈椎异常相关。     

骨性Ⅲ类错[牙合]患者双颌手术前后软硬组织的三维测量分析

目的：通过研究骨性安氏Ⅲ类错[牙合]患者双颌手术结果,评估Ⅲ类错[牙合]患者软硬组织之间的变化关系。方法：骨性安氏Ⅲ类错[牙合]畸形患者41例,采用上颌骨LeFortI型截骨和双侧下颌支矢状劈开术。分别在术前和术后6个月时进行三维CT重建测量,并对手术前、后的软硬组织变化以SPSS11.0软件包进行Pearson相关分析。结果：术后软硬组织变化有一定规律。下颌骨软硬组织移动在水平方向上高度相关（r〉0.9）,而在垂直方向上呈中度相关（0.82〉r〉0.63）。上颌骨软硬组织移动则在2个方向上均呈中度相关（0.78〉r〉0.56）到弱相关（r〈0.6）。结论：与上颌骨相比,下颌骨的软硬组织移动变化呈现强相关性;而在水平方向上的相关性也高于垂直方向。本研究得到的软硬组织移动比率对术前预测有一定帮助。     

Le FortⅠ型骨切开上颌骨整体后退术矫治骨性Ⅱ类上颌骨前突畸形

目的：探讨Le Fort Ⅰ型骨切开（Le Fort Ⅰ osteotomy）上颌骨整体后退术在矫治骨性Ⅱ类上颌骨前突畸形中的价值。方法：对16例骨性Ⅱ类上颌前突患者（上颌骨前突伴下颌骨后缩14例,其中同时伴颏后缩6例;单纯上颌骨前突2例）进行外科-正畸联合治疗。患者治疗前头影测量∠ANB为7.0°～13.1°,平均9.3°。行Le Fort Ⅰ型骨切开上颌骨整体后退术,其中14例同期行双侧下颌支矢状骨劈开术（bilateral sagittal split ramus osteotomy,BSSRO）前移下颌骨,6例行颏成形术（genioplasty）前移颏部。结果：本组行LeFortⅠ型骨切开上颌骨整体后退4～8mm,14例BSSRO下颌骨前移4～7mm,6例颏成形术颏前移6～8mm。1例一侧腭降动脉术中损伤断裂,经结扎处理,无感染及骨块坏死。16例患者伤口均一期愈合。术后及正畸结束后∠ANB为1.6°～3.5°,平均2.9°。结束治疗后随访6～24个月,牙弓形态及[牙合]曲线正常,牙排列整齐,咬合关系良好,外形明显改善,疗效满意。结论：对于骨性Ⅱ类上颌骨前突畸形患者,Le Fort Ⅰ型骨切开上颌骨整体后退术是一种安全、合理、有效的正颌外科术式。     

Postoperative mandibular stability after orthognathic surgery in patients with mandibular protrusion and mandibular deviation

Skeletal stability and temporomandibular joint (TMJ) signs and symptoms were analyzed in 23 patients in whom mandibular protrusion and mandibular deviation had been corrected using bilateral sagittal split ramus osteotomy (BSSRO group, n = 10) and unilateral SSRO and intraoral vertical ramus osteotomy (USSRO+IVRO group, n = 13). Miniplate fixation was used in SSRO but no fixation was used in IVRO. The ratio of condylar bony change was 30.4% (7/23) and all condylar bony changes were seen on the deviated side. All preoperative signs and symptoms of TMJ disorders (4/13 patients in the USSRO+IVRO group and 2/10 patients in the BSSRO group) disappeared after surgery. Comparing the USSRO+IVRO group and the BSSRO group, in patients without condylar bony change, the mandible in both groups was stable anteriorly and horizontally after surgery, even though there was a larger horizontal mandibular movement in the USSRO+IVRO group during surgery. Comparing patients with condylar bony change versus no condylar bony change in the USSRO+IVRO group, postoperative horizontal mandibular displacement was significantly larger in the condylar bony change group than in the no condylar bony change group. These results support the idea that USSRO+IVRO can be useful in correcting mandibular deviation as well as improving signs and symptoms of TMJ disorders. However, it also seems important to be aware of the possibility of horizontal mandibular relapse in patients with condylar bony change.     

Changes in occlusal force after mandibular ramus osteotomy with and without Le Fort I osteotomy

The purpose of this study was to evaluate the differences in bite force changes and occlusal contacts after sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) with and without Le Fort I osteotomy. Sixty female patients with diagnosed mandibular prognathism with or without asymmetry were divided into four groups (SSRO, IVRO, SSRO with Le Fort I osteotomy and IVRO with Le Fort I osteotomy). Bite force and occlusal contacts were measured preoperatively and at 1, 3, 6 and 12 months after surgery with pressure-sensitive sheets. The differences among surgical procedures were examined statistically. Maximum bite force and occlusal contacts returned to preoperative levels after between 3 and 6 months. Regarding time-dependent changes in bite force and occlusal contact area, there were no significant differences among the groups. In conclusion, this study suggests that the combination of IVRO or SSRO and Le Fort I osteotomy does not affect postoperative time-dependent changes.     

Postoperative stability of bimaxillary surgery in Class III patients with mandibular protrusion and mandibular deviation: a frontal cephalometric study

The aims of this study into bimaxillary surgery were to investigate and compare the postoperative stability of deviated side (lengthened side) and non-deviated side (shortened side), the effect of the type of surgery performed in the mandible, and the changes in signs and symptoms of temporomandibular joint (TMJ) disorders before and after surgery. The sample consisted of 31 Class III patients in whom imbalance between the maxilla and the mandible were corrected by Le Fort I osteotomy combined with bilateral intraoral vertical ramus osteotomy (BIVRO group, n=9), bilateral sagittal split ramus osteotomy (BSSRO group, n=10), or IVRO and SSRO (IVRO+SSRO group, n=12). IVRO+SSRO and BIVRO are more effective in improving TMJ signs and symptoms. There was no significant post-surgical difference between deviated and non-deviated sides in any group. BIVRO and BSSRO showed excellent post-surgical stability on both sides; less was found in the IVRO+SSRO group. The IVRO+SSRO group showed greater transverse displacement in menton point than the BIVRO group. In conclusion, after bimaxillary surgery and in asymmetric patients there were no differences between deviated and non-deviated sides, BIVRO and BSSRO appear to be more stable than IVRO+SSRO.     

Surgical morbidities of sagittal split ramus osteotomy versus intraoral vertical ramus osteotomy for the correction of mandibular prognathism: a randomized clinical trial

The sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) are two common orthognathic procedures for the treatment of mandibular prognathism. This randomized clinical trial compared the surgical morbidities between SSRO and IVRO for patients with mandibular prognathism over the first 2 years postoperative. Ninety-eight patients (40 male, 58 female) with a mean age of 24.4 ± 3.5 years underwent bilateral SSRO (98 sides) or IVRO (98 sides) as part or all of their orthognathic surgery. IVRO presented less short-term and long-term surgical morbidity in general. The SSRO group had a greater incidence of inferior alveolar nerve deficit at all follow-up time points (P <  0.01). There was more TMJ pain at 6 weeks (P =  0.047) and 3 months (P =  0.001) postoperative in the SSRO group. The SSRO group also presented more minor complications, which were related to titanium plate exposure and infection. There were no major complications for either technique in this study. Despite the need for intermaxillary fixation, IVRO appears to be associated with less surgical morbidity than SSRO when performed as a mandibular setback procedure to treat mandibular prognathism.     

Considerations in correction of mandibular protrusion by intra-oral vertical ramus osteotomy

This case report presents a case that underwent orthognathic treatment with intra-oral vertical ramus osteotomy (IVRO). The patient was a 19-year-old female with mandibular protrusion and severe maxillary anterior crowding. The overbite was +0.5 mm and the overjet −1.5 mm. She had orofacial pain and tenderness of the temporomandibular joints (TMJ) and surrounding muscles. The pre-surgical orthodontic treatment included the extraction of the maxillary right lateral incisor, maxillary right second premolar, maxillary left canine, mandibular left second molar and mandibular right second premolar. After 18 months of pre-surgical orthodontic treatment, the left and right sides of the mandible were set back 8 and 6 mm, respectively, via IVRO to improve mandibular protrusion. The total treatment period was 26 months. The patient showed the backward reaction of the mandible, which occurred after release of the maxillo-mandibular fixation. The usage of the Class II elastics during the post-surgical phase to maintain the overjet made the inclination of the maxillary incisors more lingual.     

Recovery of mandibular mobility following orthognathic surgery

The aim of this prospective study was to define the patterns of recovery of mandibular mobility following three commonly performed orthognathic surgical procedures. Twenty-two consecutive patients undergoing either isolated Le Fort I osteotomy (LE FORT; n = 7), sagittal split ramus osteotomies (SSRO; n = 7), or intraoral vertical ramus osteotomies (IVRO; n = 9) were studied. LE FORT and SSRO patients had no mandibular immobilization, whereas IVRO patients were immobilized by dental fixation for 3 weeks. Mandibular mobility was assessed by measurement of maximal mandibular opening (MMO) and lateral and protrusive excursions. No significant difference in MMO was observed between groups prior to surgery (LE FORT, 47.0 mm; SSRO, 50.7 mm; IVRO, 54.5 mm). A significant reduction in MMO occurred immediately after surgery in the LE FORT and SSRO groups and at release of fixation in the IVRO group. Each group returned to presurgical levels of mandibular mobility at a different rate following surgery. LE FORT patients recovered quickly, regaining 83% (mean, 38.7 mm) of MMO by 1 month and exceeded preoperative levels (mean, 49.6 mm) by 6 months. SSRO patients showed hypomobility (mean, 23.5 mm) after 1 month, with significant improvement in MMO (mean, 38.0 mm) at 2 months, and nearly complete recovery (96.2%; mean, 48.8 mm) at 6 months. IVRO patients recovered rapidly after release of dental fixation, achieving 78% (mean, 39.8 mm) of preoperative MMO at 2 months. This study shows that significant differences in recovery patterns of mandibular mobility exist between surgical procedures. The clinician should be aware of these differences in recovery patterns in defining goals for individual patient rehabilitation.(ABSTRACT TRUNCATED AT 250 WORDS)     

The assessment of blood loss in orthognathic surgery for prognathia.

PURPOSE: It is difficult to predict the need for blood transfusion during orthognathic surgery. The purpose of this study was to evaluate differences between patients who underwent different orthognathic procedures, and to assess the need for transfusion in orthognathic surgery. SUBJECTS AND METHODS: We examined 62 prognathic patients who underwent orthognathic surgery in our hospital. The subjects were divided into 4 groups according to procedure. Pre- and postoperative values of blood parameters were evaluated statistically. RESULTS: A greater amount of blood was lost in the double-jaw surgeries than in the single-jaw surgeries. There was a significant difference between sagittal split ramus osteotomy (SSRO) combined with Le Fort I osteotomy and intraoral vertical ramus osteotomy (IVRO) ( P < .05). However, none of the patients required transfusion intraoperatively. In all groups except the IVRO group, there were significant differences in red blood cell count, hemoglobin, and hematocrit between preoperative values and 1 week postoperative values ( P < .05). Although the values of red blood cell, hemoglobin, and hematocrit tended to decrease until 2 weeks postoperative, no complications occurred. Simple regression analysis showed significant positive correlation between duration of operation and blood loss ( P < .05). CONCLUSION: The present results indicate that there is little risk of marked bleeding in routine procedures, and that IVRO causes minimal bleeding. Transfusion was not necessary in IVRO or SSRO with or without Le Fort I osteotomy.     

2种不同正颌术式对骨性Ⅲ类错畸形患者上气道形态的影响

目的： 建立骨性Ⅲ类错畸形患者正颌手术前、后上气道三维模型，比较不同正颌术式对骨性Ⅲ类错畸形患者上气道各截面积及容积的影响。方法： 28例骨性Ⅲ类错畸形患者经正颌-正畸联合会诊，制定手术方案，分为2组，实验A组（12例）为单纯双侧下颌支矢状劈开术（BSSRO）后退，即单颌手术组，实验B组（16例）为下颌骨BSSRO 后退 +上颌骨Le Fort I型截骨术前移，即双颌手术组。所有患者于正颌手术前（T1）和术后3个月（T2）分别行CT扫描，基于CT图像，应用Dolphin Imaging 11.7软件建立包含腭咽、舌咽和喉咽腔在内的上气道三维模型，测量、比较2组患者在正颌手术前、后的上气道各截面、腔隙的矢状径、冠状径、横截面积和容积改变的差异。采用SPSS 16.0 软件包进行统计学分析。结果： 在腭咽段，实验A组手术后各项数值均较术前减小；实验B组手术后除冠状径外，其余数值均较术前增大，且2组变化有显著差异（P<0.05）。在舌咽段及喉咽段，2组手术后数值均减小。在横截面积和容积方面，实验A组较实验B组减小更加明显，2组的减小量有显著差异（P<0.05）。结论： 与单颌手术相比，双颌手术对骨性Ⅲ类错畸形患者上气道形态的减小改变影响较小。