正颌外科手术后患者的满意度调查

本文通过问卷回顾性地调查了１２６例位正颌外科手术１年以上患者的满意度,９３．６％的患者对手术后容貌的改变满意;８４．９％的患者愿意向有类似畸形的亲朋好友推荐正颌外科手术;７４．８％的患者愿意再选择手术;６４．３％以上的患者术后感觉自信心提高,与他人交往更自如,幸福感增强。     

正颌外科患者的术前矫治

为使正颌外科术中、术后建牙合顺利、稳定、排除牙合干扰,必需进行术前正畸．本文通过对１０例正颌外科患者术前正畸的分析讨论,提出术前正畸的必要性、矫治目的及注意事项,可进一步指导临床     

微创正颌外科的进展

微创外科是指以内镜外科代替传统外科，借助专门的器械，利用微小切口和微小创伤的外科治疗手段。与传统手术方法相比，有着诸多优越性，近年来逐渐被口腔颌面外科医师应用到一些常见疾患的诊治上，但是在正颌外科领域，微创技术的使用刚刚起步。国外一些学者进行了部分动物实验和尸体模拟操作，也有少数的临床实践报道，而国内尚未见专门的报道。本文就微创正颌外科的研究近况和发展等作一综述。     

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.     

正颌外科患者的术后正畸

目的 :探讨术后正畸的必要性及矫治的目的。方法 :对 10例正颌外科患者术后正畸的分析讨论。结果 :术后矫正可进一步改善正颌外科患者的关系。结论 :正颌外科术后要取得良好的关系 ,建立平衡 ,必需进行术后矫正     

正颌外科术后患者的满意度调查

本文通过问卷回顾性地调查了126位正颌外科术后1年以上患者的满意度。93．6%的患者对手术后容貌的改变满意;849%的患者愿意向有类似畸形的亲朋好友推荐正颌外科手术;74.8％的患者愿意再选择手术;64.3％以上的患者术后感觉自信心提高,与他人交往更自如,幸福感增强。     

人工智能时代的正颌外科发展

简要回顾人工智能（AI）技术的概念及其在不同时代发展历程,概述AI在医疗领域的应用,回顾综述AI在正颌外科发展的研究进展、存在的问题及可能的发展方向,指出AI在正颌外科的发展充满机遇与挑战并存。     

我国正颌外科近年来的进展

我国正颌外科近年来的进展张震康正颌外科（ｏｒｔｈｏｇｎａｔｈｉｃｓｕｒｇｅｒｙ）在我国的兴起始于本世纪７０年代末期和８０年代初期，以１９８５年在青岛召开的“第一次全国外科正畸学术讨论会”以及１９９０年在北京召开的“国际正畸与外科正畸学术会议”为标志。...     

三维可视化术前宣教对正颌患者心理状况的影响

目的: 研究三维可视化术前宣教对正颌患者焦虑及抑郁心理的影响。方法: 选取2015年12月—2016年6月于上海交通大学医学院附属第九人民医院口腔颅颌面科行正颌手术治疗的患者240例,随机分为试验组及对照组,每组120例。术前对试验组患者采用三维可视化术前宣教方法配合常规术前书面宣教,对照组患者仅采用常规书面术前宣教。宣教后,填写调查问卷,包括一般情况调查表、SAS焦虑自评量表及SDS抑郁自评量表。采用SPSS17.0软件包对2组患者的自评量表结果进行统计学分析。结果: 2组患者的一般情况包括年龄、性别、教育程度、职业的差异均无统计学意义（P>0.05）,具有可比性。对照组分别有9例患者出现术前焦虑,11例患者出现术前抑郁;试验组分别有1例患者出现术前焦虑,1例患者出现术前抑郁。与对照组相比,试验组术前出现焦虑患者人数下降6.7%（P<0.05）,术前出现抑郁患者人数下降8.3%（P<0.05）。结论: 三维可视化术前宣教有助于改善正颌患者术前焦虑及抑郁心理,降低患者出现术前焦虑及抑郁的几率,促使患者能以良好的心态面对手术。     

数字化技术用于25例患者正颌手术效果评价

目的:应用数字化技术辅助正颌外科三维重建测量、术前诊断、手术设计与模拟、导板制作、导航验证和效果评估,探索制订更加科学、合理的数字化诊治方法和流程.方法:选取25例先天性牙颌面畸形患者,术前行颅颌面CT扫描,将CT数据导入Mimics 20.0软件,建立数字化原始模型.确定三维重建测量硬组织标志点并进行测量、分析、诊断...     

数字化技术在正颌外科及创伤外科临床教学中的应用

目的：探讨数字化技术在创伤外科和正颌外科教学中的应用价值。方法：选择中国医科大学2009级口腔医学本科生62名,其中男生24名,女生38名,采用分层随机原则分成实验组和对照组,每组男生12名,女生19名。对照组结合多媒体幻灯片,采用传统教学方法讲授课本内容;实验组采用数字化技术结合具体病例进行讲授、实际操作。2个学时授课结束后,针对课堂指出的教学重点内容进行测试,同时对每组学生的学习兴趣进行自我评价。采用SPSS17.0软件包对实验组和对照组的分数进行t检验。结果：实验组考试分数为73.29±8.75分,对照组为67.29±8.96分;实验组学习兴趣评分为8.33±0.80分,对照组为6.33±1.13分,2组在测试成绩和自我评价得分中的差异均有显著性（P＜0.05）。结论：将数字化技术运用到正颌外科及创伤外科的实践教学中,有助于提高学生的学习兴趣,加强对重点知识的掌握,值得在教学中推广应用。     

Changes in quality of life after orthognathic surgery in Saudi patients

Aim

This study was conducted to measure the impact of orthognathic surgery on quality of life in Saudi patients.

Materials and methods

Patients with a discrepancy of 5 mm or more who underwent orthognathic surgery either single jaw or bimaxillary at the Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, between September 2007 and June 2013 were included in the study. They were asked to complete the Arabic version of the 22-item Orthognathic Quality of Life Questionnaire (OQLQ) preoperatively and postoperatively. Responses at these two timepoints were compared using paired t-tests, with the significance level set to P < 0.05.

Results

Seventeen patients participated in the study. Total OQLQ scores and those in the instrument’s four domains (oral function, facial aesthetics, awareness of dentofacial aesthetics, and social aspects) indicated that quality of life was significantly improved by orthognathic surgery (all P < 0.001).The social aspect domain was shown to be more important for patients than were facial aesthetics and oral function.

Conclusion

The present study revealed highly significant improvement in Saudi patients’ quality of life following orthognathic surgery. This improvement was evident in all four OQLQ domains.     

A new model of customized maxillary guide for orthognathic surgery: Precision analysis

PurposeTo evaluate the surgical accuracy of a new Maxillary Bone-Dental-Supported guide (MBDS) for osteotomy and maxillary positioning in orthognathic surgeries.Materials and methodsThe customized MBDS were prototyped through CAD-CAM technology (computer-aided design and manufacturing). The planning image (CT0) was superimposed on the computed tomography scan post-treatment (CT1) and the mean of positional differences between them were obtained tridimensionally at the axes: mediolateral (X), anteroposterior (Y) and vertical (Z).ResultsEleven patients were selected according to the inclusion and exclusion criteria. The mediolateral movement showed the best precision, with a greater mean difference of 0.34 mm at the CI point (central incisor) and less than 0.02 mm at the RM point (right molar). In the vertical direction, the largest mean discrepancy found was 0.50 mm and on the y-axis, anteroposterior, was 0.74 mm, as well as two at the CI point. The skeletal SNA point, on the other hand, showed the smallest average discrepancies: 0.10 mm (x-axis), 0.03 mm (y-axis) and 0 mm (z-axis). Overall, 99.24% of the discrepancies found were less than 2 mm.ConclusionOur results suggests that the double support, osseous and dental, present in that new guide, favored the positional stability of the maxilla and promoted better control of its vertical axis. Furthermore, the function of an osteotomy guide increases the predictability and security of the surgical procedure.     

Systematic review of thromboprophylaxis in patients having orthognathic surgery

Orthognathic surgery is an elective procedure that is done in healthy individuals so complications such as thromboembolic events are rare. Pharmacological thromboprophylaxis, which reduces the risk of these events, may also increase blood loss and potentially the risk of life-threatening haemorrhage, so a state of clinical equipoise exists about whether it should be given routinely. We systematically reviewed published papers to identify the incidence of venous thromboembolism and haemorrhage in patients treated by orthognathic surgery who were, and were not, given pharmacological thromboprophylaxis. The pooled incidence of thromboembolic events was 0% in those who were, and 0.19% in those who were not. Return to theatre to control bleeding was required in 2.72% of the patients treated at centres where it was given, and in 0.55% at those where it was not. Small sample sizes, the heterogeneity of treatment protocols, and incomplete reporting made further statistical analysis impossible. The incidence of venous thromboembolism in patients who have orthognathic surgery is low when compared with the rest of the hospital population. Although pharmacological thromboprophylaxis may further reduce this, it can also increase blood loss, and uncertainty therefore remains over the best protocol for its routine use. The risk stratification of individual patients, and large randomised controlled trials are now required to establish the best treatment.     

Mandibular asymmetries and associated factors in orthodontic and orthognathic surgery patients

Objectives:To estimate the prevalence of mandibular asymmetries in orthodontic and orthognathic surgery patients and to investigate demographic and skeletal factors associated with this disharmony.Materials and Methods:Cone-beam computed tomography images of 1178 individuals aged 19 through 60 years with complete dentitions were analyzed. Outcomes were classified as relative mandibular symmetry, moderate asymmetry, and severe asymmetry. Factors recorded included sex, age, side of mandibular deviation, sagittal jaw relationship, vertical skeletal pattern, angle of the cranial base, and maxillary asymmetry. Ordinal logistic regression was used to estimate simple and adjusted odds ratios (OR) for the individuals with moderate and severe mandibular asymmetry, as well as 95% confidence intervals.Results:Prevalence values of 55.2%, 27.2%, and 17.6% were observed for relative mandibular symmetry, moderate asymmetry, and severe asymmetry, respectively. An independent association with the side of mandibular deviation and the presence of maxillary asymmetry was observed, both for subjects with moderate mandibular asymmetry (left side: OR = 1.50; 95% CI: 1.01–2.24 / maxillary asymmetry: OR = 2.07; 95% CI: 1.11–3.76) and for those with severe asymmetry (left side: OR = 2.09; 95% CI: 1.27–3.44 / maxillary asymmetry: OR = 4.93; 95% CI: 2.64–9.20).Conclusions:Moderate and severe mandibular asymmetries were present in 44.8% of the sample, being associated with the side of mandibular deviation and with maxillary asymmetry.     

The accuracy of two-dimensional planning for routine orthognathic surgery

Two-dimensional cephalometric planning software should be helpful for prediction of hard tissue outcome after bilateral sagittal split ramus osteotomy (BSSRO) or bimaxillary osteotomy, but transferring two-dimensional data to three-dimensions (including mock operation and surgery) may result in errors. The objective of this retrospective study was to analyze deviations between predicted results and postoperative outcome using cephalometric analyses, and to evaluate this procedure for daily use. Fifty-four subjects (mean (SD) age 26 (8) years) had a BSSRO (n = 21) alone or in combination with Le Fort I osteotomy (n = 33). Predictions were made for each case by cephalometric planning software and mock operations done with study models. Postoperative cephalograms were obtained after 14 days and compared with predicted cephalograms for sagittal (SNA, SNB, ANB,) and vertical (ArMeGo, ML–NSL, NL–NSL) measurements. Mean (SD) differences for all measurements varied between 1.3° (1.1°) and 2.2° (1.6°) for BSSRO; and between 1.1° (1.3°) and 2.2° (1.6°) for bimaxillary osteotomy. There were no significant differences between measurements or operations, indicating that the predictions were accurate. A difference of up to 8.5° could be measured in a single case. Cephalometric prediction therefore remains an accurate tool for planning, particularly maxillary rearrangement in the vertical and sagittal dimension for routine operations. If greater shifts in the transversal dimension are necessary, exact planning should be adapted with three-dimensional planning devices to avoid significant differences.