双侧下颌骨升支矢状劈开截骨术治疗下颌前突畸形

目的探讨口内进路双侧下颌骨升支矢状劈开截骨后退小钛板内固定治疗重度下颌前突畸形的临床疗效。方法9例上颌骨发育正常、下颌骨真性前突、严重反He关系的患者，行术前牙齿正畸治疗后，采用口内进路双侧下颌骨升支矢状劈开截骨后退小钛板内固定，术后正畸治疗，恢复尖窝咬He关系。结果所有病例均取得满意的疗效，获得协调的上下颌骨关系，术后随访1年，未见下颌前突复发。结论重度下颌前突畸形采用口内进路双侧下颌骨升支矢状劈开截骨术及正畸治疗是有效的，值得临床推广应用。     

下颌升支矢状劈开截骨术后退和前徙下颌骨对合力和咀嚼效能的影响

作者对２１例接受下颌升支矢状劈开截骨术患者（下颌前突１１例，下颌后缩１０例）术前、术后３个月及６个月的殆力和咀嚼效能进行了测定和分析。结果表明：下颌前突的个体行下颌骨后退术后，其哈力和咀嚼效能增加；下颌后缩的个体行下颌骨前徙术后，其力和咀嚼效能降低。力的改变与下颌骨移动的距离和角度以及面下份高度的变化均无直线相关关系（Ｐ＞０．０５）。     

下颌前突外科手术前后的正畸治疗

目的 总结、分析口腔正畸－正颌外科联合矫治下颌前突畸形的治疗经验,以指导临床工作。方法 对４０例年龄为１７￣３８岁的下颌前突患者经口腔正畸与正颌外科联合矫治的资料进行分析。结果 ４０例下颌前突患者平均术前正畸治疗时间９个月（２￣２５个月）,术后正畸治疗时间７．６个月（２￣１５个月）。整个治疗过程平均１６个月（４￣２５个月）。术前正畸治疗的目标为排齐上下牙列,完成切牙和磨牙的去代偿治疗,整平牙例,协     

下颌升支矢状劈开截骨术对下牙槽神经功能的影响

自Obwegeser首次报道下颌升支矢状劈开截骨术 (SSRO)以来 ,该手术现已成为临床上广泛应用的正颌外科技术。但是常见的并发症就是术后可能导致下牙槽神经功能紊乱。本文就SSRO术后下牙槽神经功能受损的病因、神经功能紊乱的检测方法、预防及治疗方面综述如下。1　发生率SSRO术后立即出现下牙槽神经功能紊乱的发生率为 5 4%～ 10 0 % [1] ,大多数病人的神经功能在术后 3～ 6个月可得以恢复 ,但也可遗存永久性神经损伤。这与采用检测神经功能方法不同、检测神经功能时缺乏有效对照、以及术者操作技巧等有关。2　SSRO后下牙槽神经功能紊…     

口内路径下颌骨升枝矢状劈开截骨术治疗下颌前突畸形

下颌骨升枝矢状劈开术是目前世界上使用最普遍的矫正下颌骨畸形的手术方法之一。作者采用口内入路下颌骨畸形的手术方法之一。作者采用口内入路下颌骨升枝矢状劈开截骨术治疗下颌骨前突１８２例，其中真性下颌前突１４３例，假性下颌前突３９例。年龄在１５～５８岁之间，平均２４岁。随访６个月～９年。除９例术后畸形复发需再次矫正以外均获满意效果。本文介绍了口内入路下颌骨升枝矢状截骨术的手术过程及注意事项，并着重讨论了其优缺点，可能出现的并发症及处理方法     

下颌升支矢状劈开截骨术矫治下颌前突体会

下颌升支矢状劈开截骨术矫治下颌前突体会山东莱钢医院口腔科吴洪敏，陶书振１９８９年以来我科采用下颌升支矢状劈开截骨术（Ｓａｇｉｔｔａｌｓｐｌｉｔｒａｍｕｓｏｓｔｅｏｔｏｍｙ，ＳＳＲＯ）矫治下颌前突畸形１０例，取得良好效果，现总结如下。临床资料本组１０例...     

坚强内固定在下颌升支矢状劈开截骨术中的应用

<正> 正颌外科的坚强内固定技术是在借用了外伤骨折处理中的钢板螺钉固定方法的基础上,为了保证正颌外科术后截骨块的稳定性,减少术后并发症及防止术后复发而发展起来的,并成为正颌外科中一个必不可少的组成部分。作者于1996年6月～2003年3月采用坚强内固定技术进行下颌升支矢状劈开截骨术28例,现就治疗体会总结如下。     

下颌升支矢状劈开截骨术后退和前徙下颌骨对He力和咀嚼效能的…

作者对２１例接受下颌升支矢状劈开截骨术患者（下颌前突１１例，下颌后缩１０例）术前、术后３个月及６个月的Ｈｅ力和咀嚼效能进行了测定和分析，结果表明：下颌前突的个体行下颌骨后退术后，其Ｈｅ力和咀嚼效能增加；下颌后缩的个体行下颌骨前徙术后，其Ｈｅ力和咀嚼效能降低。Ｈｅ力的改变与下颌移动的距离和角度以及面下 份高度的变化均无直线相关关系（Ｐ＞０．０５）。     

下颌升支矢状劈开截骨术并发症的原因和预防

如何预防正颌外科手术并发症是一个值得探讨的重要课题。作者总结１８例下颌升支矢状劈开截骨术，其中骨段移位３例，感染１例，下齿槽神经损伤４例，出血１例，作者着重分析各种常见并发症的原因及其预防。     

下颌升支矢状劈开截骨术并发症的原因和预防

如何预防正颌外科手术并发症是一个值得探讨的重要课题。作者总结１８例下颌升支矢状劈开截骨术，其中骨段移位３例，感染１例，下齿槽神经损伤４例，出血１例。作者着重分析了各种常见并发症的原因及其预防。     

Inverted-L osteotomy for correction of mandibular prognathism after relapse.

As more orthognathic surgery is performed, more case of relapse can be expected. A case of re-operation of a recurrent prognathism has been reported. An alternative surgical approach was used because the planned operation could not be accomplished. However, the implications of the use of the technique are broader than the single example given in this report. The inverted-L technique, because of its similarity to the combined oblique osteotomy and coronoidectomy for correction of extreme prognathism, provides an alternative procedure that leaves a greater proportion of the masticatory musculature in its natural position. In addition, with the development of techniques and instrumentation for intraoral approaches to oblique osteotomy of the ramus, the feasibility of an intraoral inverted-L osteotomy becomes apparent and the approach merits further consideration.     

Head posture and pharyngeal airway volume changes after bimaxillary surgery for mandibular prognathism

PurposeThe purpose of this study was to evaluate head posture and the pharyngeal airway volume changes using 3D imaging after bimaxillary surgery in mandibular prognathism patients by null hypothesis.Materials and methodsCone-beam computed tomography (CBCT) scans were obtained for 25 mandibular prognathism patients before bimaxillary surgery (T1) and 6 months after surgery (T2). The head posture of each patient was assessed by measuring cranio-cervical angle on a midsagittal plane passing through the anterior nasal spine at T1 and T2. Additionally, the volume of each subject's pharyngeal airway was measured using InVivoDental 3D imaging software.ResultsThe cranio-cervical angle increased significantly 6 months after bimaxillary surgery (p < 0.01). The total volume of the pharyngeal airway slightly decreased (p > 0.05) at the same timepoints, while naso- and oro-pharyngeal airway volume decreased significantly (p < 0.05, p < 0.05). There was significant relationship between the changes of head posture and those of total airway volume (p < 0.05).ConclusionThe null hypothesis was rejected. Bimaxillary surgery resulted in significant head flexion and a slight decrease in total pharyngeal airway volume.     

Factors contributing to skeletal relapse after surgical correlation of mandibular prognathism

Postoperative follow-up and multiple regression analysis of skeletal relapse following mandibular setback were carried out to clarify the timing and causes of the relapse. The subjects were 24 mandibular prognathism patients. All patients underwent intraoral oblique sagittal splitting osteotomy with circumferential wiring and intermaxillary fixation for 8 weeks. Occlusal splints were not used. Postoperative positional changes of segments were evaluated by lateral cephalograms taken at appropriate intervals. Horizontal relapse was most evident within six months after surgery; vertical relapse seldom occurred. Multiple regression analysis revealed little association between preoperative morphological patterns and postoperative relapse. Although spatial changes of the proximal segment at operation and age of the patient were the best predictors for postoperative horizontal relapse, analysis indicated unsatisfactory prediction of vertical relapse because of its rare occurrence. Based on these results, the aetiology of relapse is discussed and two proposals are suggested for its prevention.     

Evaluation of vertical ramus osteotomy for the surgical correction of unilateral mandibular posterior vertical insufficiency: Long-term follow-up results

PurposeUnilateral posterior vertical insufficiency (PVI) is a growth defect of the mandibular condyle that results in a facial asymmetry. Various surgical procedures can be used to elongate the hypoplastic ramus. The aim of this study was to evaluate long-term aesthetic and architectural outcomes of vertical ramus osteotomy (VRO) in patients with unilateral PVI.Materials and methodsPatients operated on with unilateral VRO were included in this retrospective study. Aesthetic and architectural parameters were evaluated on frontal photographs as well as on frontal and lateral cephalograms preoperatively, postoperatively, at 1-year and at the end of the follow-up.ResultsA total of 48 patients were analyzed. The aesthetic assessment revealed significant correction of the chin deviation (CD) and of the lip commissural line tilt after VRO (p1 = 0.0038 and p2 = 0.0067, respectively) with stable results. The architectural analysis revealed significant improvement in the maxillary and mandibular occlusal planes, as well as the chin deviation (p < 0.0001). A tendency to relapse was noted for the mandibular canting and the CD during the follow-up. VRO allowed for a mean mandibular lengthening of 8.39 mm (ranging from 2.5 to 14 mm).ConclusionVRO allows for immediate restoration of the symmetry of the lower third of the face in patients with unilateral PVI. A revisional procedure may be needed due to a tendency for the chin deviation to relapse.     

正颌外科矫治骨性下颌偏斜的术前及术后正畸治疗

目的　分析、总结临床采用正畸 正颌外科方法联合治疗严重骨性下颌偏斜畸形时术前与术后正畸治疗中的难点和要点 ,为临床工作提供参考。方法　严重骨性下颌偏斜畸形患者 2 1例 ,年龄 19～ 2 8岁 ,平均年龄 2 5 5岁。ANB角 - 3°～ - 8° ,Wits值 - 7～ - 14mm ,颏点偏斜 3～ 7mm。所有患者均接受术前及术后正畸治疗。结果　术前正畸疗程为 10～ 2 0个月 ,平均 18个月。术后正畸疗程为 5～ 10个月 ,平均 7 5个月。术前正畸治疗必须要解决以下主要难点 :①去除患者三维方向的牙代偿 ;②协调其牙弓形态及宽度的不调 ;③双颌手术时模型外科分析与导板的制作。术后正畸治疗的主要目的是对咬合关系进行精细调整。结论　术前术后正畸治疗是正颌外科治疗下颌偏斜畸形取得良好效果的必要保证     

Deglutitive tongue movement after correction of mandibular protrusion: A pilot study

Objective:To investigate any change in deglutitive tongue movement following the correction of malocclusion by orthognathic surgery.Materials and Methods:The subjects were nine patients with mandibular protrusion. A control group consisted of 10 individuals with a similar age range and normal occlusion. Swallowing events before and after mandibular setback via sagittal split ramus osteotomy were recorded by cineradiography, and the tongue movement was analyzed. Time and linear measurements were compared before and after surgical treatment by the Wilcoxon signed rank test; control and test subjects were compared with the Mann-Whitney U-test.Results:Tongue-palate contact and the tongue-tip position changed after orthognathic surgery and became similar to those of the controls. Movements of the anterior and middorsal regions of the tongue did not change after orthognathic surgery and remained different from those of the controls.Conclusion:Our findings suggest that tongue-palate contact and tongue-tip position during deglutition adapted to the corrected oral and maxillofacial morphology, but the anterior and middorsal regions of the tongue during deglutition may have been affected by pharyngeal constrictors rather than by the oral and maxillofacial morphology.     

Surgical guide and CAD/CAM prebent titanium plate for sagittal split ramus osteotomy in the correction of mandibular prognathism

This study was designed to introduce and evaluate the clinical use of a surgical guide and a CAD/CAM prebent titanium plate for sagittal split ramus osteotomy (SSRO) in the correction of mandibular prognathism. We studied 14 patients who had been diagnosed, and treated by bilateral SSRO with the guide, during the period July 2015–January 2016. Surface deviations of distal segments from simulation until the end of the operation were measured on a coloured map. Deviations of position and orientation of the condyle and proximal segment from before to after operation, and those from simulation until the end of the operation, were measured with a 3-dimensional vector. All patients were followed up for at least a year. The coloured map showed that the mean (SD) distances were 0.40 (0.25) mm between the simulated and postoperative distal segments. The 3-dimensional vector showed that the mean values of mediolateral, anteroposterior, and superior-inferior translations of the condyles were less than 1 mm (p < 0.02) from before the operation until the end, and from simulation to the end of the operation, and the mean value of pitching for proximal segments was less than 1° (p < 0.02) from simulation to the end of the operation. At the one year follow-up, the occlusions were stable. Based on accurate diagnosis and simulation, this guide takes the distal segment precisely to its planned position, and the condyle and proximal segment are well-controlled. This is a useful tool, which is comparatively easy to make and operate.     

Postoperative stability of two common ramus osteotomy procedures for the correction of mandibular prognathism: A randomized controlled trial

The aim of this randomized controlled trial was to compare the skeletal stability between sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) in the treatment of mandibular prognathism. Patients presenting with mandibular prognathism and scheduled for orthognathic surgery were randomized into either the SSRO group or the IVRO group. Changes at B-point were assessed by serial tracing of lateral cephalograms, which were taken preoperatively, and at 2 weeks, 6 months, 1 year, and 2 years postoperatively. Ninety-eight patients were recruited, with 49 patients in each group. Between 2 weeks and 6 months postoperatively, there was significantly more surgical relapse in the horizontal direction (anterior movement) in the SSRO group when compared with the IVRO group (1.83 mm (SD 2.91 mm) vs 0.49 mm (SD 2.32 mm); p = 0.019). At 2 years, there was more surgical relapse in the horizontal direction in the SSRO group than in the IVRO group (0.27 mm (SD 0.34 mm) vs 0.10 mm (SD 0.29 mm); p = 0.014). There were also more absolute changes (irrespective of direction) at B-point in the SSRO group than in the IVRO group at postoperative 6 months, 1 year, and 2 years (p = 0.016, 0.049, and 0.045, respectively). The amounts of change at B-point as percentages of total mandibular setback were 1.3% and 3.5% in the IVRO group and SSRO group, respectively. There were no differences in vertical changes between the two groups at any time points. In conclusion, the horizontal stability at B-point was shown to be superior in the IVRO group compared with the SSRO group in the correction of mandibular prognathism during the 2-year follow-up. Although the exact clinical importance of this difference is unknown at this time, this possible benefit may be an important key factor when deciding which osteotomy technique to employ for mandibular setback.