正畸正颌联合治疗唇腭裂继发牙颌面畸形

目的评价正畸正颌联合治疗唇腭裂继发牙颌面畸形的疗效。方法回顾性研究2000年7月～2005年9月广东省口腔医院治疗的20例唇腭裂继发牙颌面畸形患者。20例患者均行术前及术后正畸治疗,单纯采用上颌骨LeFortⅠ型截骨前移者1例,单纯采用双侧下颌升支矢状劈开后退术者1例,行LeFortⅠ型截骨前移术 双侧下颌升支矢状劈开后退术者15例,行LeFortⅠ型截骨前移术 双侧下颌升支矢状劈开后退术 颏成型术者3例。17例患者在正颌手术前行牙槽裂植骨。结果经治疗患者上颌前移(5.5±1.2)mm,下颌后退(7.2±2.5)mm。患者唇颏关系改善明显,咬合关系良好,但大部分患者鼻部仍有塌陷及偏斜畸形。患者术前后语音状况经语音师评估均无明显变化。结论正畸正颌联合治疗唇腭裂继发牙颌面畸形,可以较好地改善患者的容貌并取得良好的咬合关系。     

常见正颌手术后咬合关系的维护和调整

目的 探讨临床常见的正颌手术后,如何很好的维护和调整上下牙列的咬合关系,为临床提供有益的参考.方法 选择骨性Ⅰ类双颌前突行根尖下截骨后徙术、Ⅱ类下颌后缩行下颌升支矢状劈开前徙术、Ⅲ类骨性反骀行下颌升支骨切开后退及合并上颌前徙术各6例患者,共18例患者.正颌手术后依据分类分别行3种不同的牵引模式进行咬合调整.结果 18例...     

牵张成骨联合正颌正畸治疗成人严重小下颌畸形

目的：探讨牵引成骨技术联合正颌正畸治疗重度小下颌伴偏颌畸形患者下颌骨严重发育不足及咬合关系紊乱的疗效。方法：对2例继发于儿童时期颞下颌关节损伤的小下颌伴偏颌畸形患者采用牵张成骨技术进行治疗。手术行双侧下颌角处截骨,安置牵引器,延长下颌升支及下颌体。第二期在拆除牵引器后进行正畸治疗,继而采用正颌外科方法进一步矫正颌面畸形及咬合关系,术后正畸治疗矫正咬合关系,排齐牙列。结果：2例患者均顺利完成治疗。下颌骨最小牵引距离25 mm,最大牵引距离30 mm,牵引区成骨良好,SNB角由术前平均67°增加到术后80°,小下颌及偏颌畸形得以矫治。联合正颌外科及正畸治疗后,面形及咬合功能均获得满意效果。术后经过2年6个月随访,未见复发。结论：联合应用牵张成骨和正颌外科技术并配合正畸治疗是矫治成人重度小下颌不对称性牙颌面畸形的有效治疗方案。     

颌骨畸形600例正颌手术治疗

目的 总结正颌外科矫正颌骨畸形的临床经验。方法 对600例颌骨畸形患者进行正颌外科手术,其中上颌Le FortⅠ截骨与下颌体部截骨术212例,单纯上颌Le Fort Ⅰ截骨56例,单纯双下颌升支矢状劈开截骨(SSRO)30例,下颌体部截骨145例,行Downfracture或Wassmund法矫治112例,下颌前突伴偏颌畸形行下颌体部截骨45例。结果 60X例中术后部分复发28例,完全复发2例,下唇感觉异常9例,术后感染6例,其余术后面容和咀嚼功能获得满意效果。结论 上颌Le Fort Ⅰ截骨与下颌体部截骨术能较好地矫正上颌后缩及下颌前突畸形,但牙颌关系恢复不良。前牙根尖下截骨是纠正双颌前突畸形的理想术式,SSRO矫正下颌前突畸形效果满意。     

坚强内固定技术在正颌手术中的应用

目的：总结坚强内固定技术在正颌手术中应用的经验。方法：对4l例接受正颌手术的患者采用不同形状钛板行坚强内固定，其中下颌升支矢截骨术(sagittal split ruams osteotomy)20例，颏成形术(genioplasty)7例，Le Font截骨术5例，上颌前份截骨术(anterior maxillay osteotomy)5例，双颌手术(bimaxillary surgery)4例。按以下程序进行操作：先恢复预期咬合关系并暂行颌间栓结，然后对截开骨段进行坚强内固定，最后拆除暂行的颌间栓结，同时检查咬合关系。结果：采用坚强内固定的患者颌问栓结时间较传统固定方法明显缩短，经过术后1个月、3个月和6个月随诊复查，发现所有截骨段均愈合良好，患者下颌运动功能在较短时间内恢复到术前状态，所有患者均未诉有不适感。结论：坚强内固定技术是正颌外科中固定截骨段最好的方法之一，它可以加速骨段间的愈合速度，减少颌间栓结时间，便于患者营养的摄取和保持口腔卫生，利于患者术后功能的恢复。     

下颌升支矢状劈开截骨术后颞下颌关节形态和功能变化

下颌升支矢状劈开截骨术 (ＢＳＳＲＯ)对颞下颌关节(ＴＭＪ)形态和功能的影响是很多学者研究的问题 ,且对下颌升支矢状劈开截骨术后颞下颌关节是否发生形态改变和关节功能紊乱存在争议[1] 。本文通过 16例下颌升支矢状劈开截骨术的病例对颞下颌关节是否发生形态改变和关节功能紊乱进行了随访研究。1　材料与方法1.1　一般临床资料1996年 1月～ 2 0 0 1年 12月共 130例正颌外科手术。从中选出 16例下颌双侧升支施行矢状劈开截骨术 (ＢＳＳＲＯ)的病例进行随访研究 ,其中女 7例 ,男 9例 ,平均年龄 2 3.5 (18～ 2 6 )岁。下颌前突 11例 ,上颌后…     

下颌升支截骨术不同术式对口颌系统功能影响的比较

目的 比较下颌升支矢状截骨术（ＳＳＲＯ）和下颌升直垂直截骨术（ＩＶＲＯ）后退下颌对口颌系统功能的影响。方法 ２７例下颌前突患者（１６例接受ＳＳＲＯ,１１例接受ＩＶＲＯ）分别在术前、术后３个月、６个月测定Ｈｅ力、咀嚼效能及髁突位置。结果 术后３个月时,两组患者的Ｈｅ力、咀嚼效能均有不同程度下降,ＩＶＲＯ组下降更为明显。术后６个月时,ＳＳＲＯ组患者的Ｈｅ力、咀嚼效能的均值已越过术前,而ＩＶＲＯ组患者的     

正颌外科技术在颌面部陈旧性骨折中的应用

目的:探讨正颌外科技术在颌面部陈旧性骨折中的临床应用,以寻找恢复面部外形和正常咬合关系的方法.方法:对20例颌面部陈旧性骨折患者,术前经三维CT重建、头影测量分析、模型外科等确定截骨部位及手术方案.对有咬合关系错乱者,制作定位咬合导板,然后采用正颌外科技术在预定部位截骨或截开错位愈合骨段.恢复骨段连接、咬合关系及面形后,予以坚强内固定.结果:20例患者术后均恢复了正常面形,咬合关系满意,其中4例行上颌骨截开者,上颌骨前外侧壁发生骨不愈合,2例出现口腔上颌窦瘘.结论:利用正颌外科设计程序和截骨手段结合坚强内固定技术治疗颌面骨陈旧性骨折,在将错位骨愈合的骨段重新复位或设计骨段移动到位的情况下,可恢复良好的面部外形和最大限度地改善咬合关系.     

腭裂伴发牙颌畸形正颌治疗的述评

本文报告２０例腭裂伴牙颌畸形的正颌治疗。手术方法：上颌作ＬｅＦｏｒｔＩ型截骨术，下颌作矢状劈裂截骨术，上颌作牙槽骨段截骨术和上，下颌联合作牙槽骨段截骨术。临床效果：与腭裂修复术同期施行ＬｅＦｏｒｔＩ型截骨术者，容貌与功能均获得改善，在腭裂修复术后，分期作ＬｅＦｏｒｔ型截骨术者，术后６周即出现复发现象。下颌行矢状劈裂截骨术皆能获得预期效果，单颌或双颌作牙槽骨段截骨术者，无论是同期还是分期手术，都属效果满意病例。本文着重对手术指征，手术术式，术后复发、同期手术进行述评，并主张该手术能改善容貌与咀嚼功能即是确当的方法，不必要求以美貌人的标准来苛求划一。     

下颌偏突颌畸形患者手术前后（牙＋合）力、咀嚼效能的变化

目的：研究下颌偏突颌畸形患者手术前后胎力,咀嚼效能的变化,并探讨其影响因素．方法：从2008年2月～2008年10月对24例在武汉大学口腔医学院接受正颌手术的下颌偏突颌畸形患者。根据畸形的具体情况,将其分为两组,仅接受双侧下颌升支矢状劈开截骨术16例（单颌治疗组）,接受LeFort Ⅰ型截骨术合并双侧下颌升支矢状劈开截骨术8例（双颌治疗组）。利用咬合力计和分光光度计分别对两组患者术前、术后l、3、6个月的胎力和咀嚼效能进行测定。结果：术后1个月时,两组患者胎力及咀嚼效能显着低于术前。术后3个月时,两组患者胎力和咀嚼效能已有明显改善。术后6个月时,单颌治疗组患者的胎力均值超过术前,而双颌组患者的咀嚼效能均值也高于术前。结论：正颌手术短时间内对下颌偏突颌畸形患者的胎力、咀嚼效能影响较大。随着手术后患者对新的胎关系逐渐适应,其胎力和咀嚼效能均有明显变化。单颌治疗组胎力改善较快,双颌治疗组咀嚼效能提高更明显。     

下颌前突畸形的正颌外科矫治

目的 总结正颌外科矫治下颌前突畸形的临床经验。方法 对32例下颌前突畸形患者进行了正颌外科手术，其中12例行双侧SSRO，4例行双侧IORO，10例行双侧IVRO，5例行上下颌前部根尖下截骨，1例行下颌骨体部截骨，同期搭配施行水平截骨颏成形术12例，畸形涉及上颌骨行LeFortⅠ型截骨9例。结果 32例下颌前突畸形患者术后外观及功能均获得满意效果。并发症有术后下颌前突轻度复发4例，明显复发1例，下颌骨升支骨折一侧1例，下牙槽神经一侧断离1例，结论 随访结果显示应用IVRO，SSRO等术式治疗下颌前突畸形只要术式选择及操作得当，能获得较满意效果。文中就手术方法，注意事项及并发症等进行了讨论。     

下颌支矢状骨劈开术并发症防治的专家共识

下颌支矢状骨劈开术（SSRO）是正颌外科中最为常用的一类矫治下颌骨畸形的手术。由于局部解剖和操作步骤的复杂性,SSRO出现各类并发症的可能性较大,甚至可能造成严重的不良后果。诊疗策略的选择及转归与并发症的类型及其临床表现密切相关。为此,国内相关专家编写本共识,对SSRO各类常见并发症的原因、预防、处置措施进行阐述,以期提高广大同行对SSRO并发症的认识,确保手术安全进行并获得良好效果。     

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.     

下颌前突患者升支矢状劈开术前后咀嚼肌的肌电分析

目的测量下颌前突患者行正颌手术前后的肌电值，分析矢状劈开截骨术（SSRO）后咀嚼肌系统的变化，进一步探讨肌电的改变与术后咀嚼肌适应性改建之间的关系。方法选取18例接受SSRO治疗的下颌前突患者，记录术前及术后3个月、1年时主要咀嚼肌在功能运动中的电生理指标，计算相关参数并进行统计分析。结果下颌前突患者在正常状态下，大部分肌电指标低于健康对照组；行SSRO治疗后3个月，咀嚼肌的肌电指标有所下降，部分指标明显低于术前；术后1年，肌电指标较术前有明显上升，但部分仍低于健康对照组。结论正颌术后，咀嚼肌系统的重建是一个长期的过程，与术前相比较，咀嚼肌的性能得到了一定程度的改善。     

正颌外科矫正牙颌面畸形300例总结

目的为总结正颌外科矫正牙颌面畸形的临床经验,方法对300例牙颌面畸形患者进行了正颌外科手术,其中180例上颌前突和上颌前部发育不足畸形,行上下颌前部根尖下戴骨术;40例上下颌后牙正反锁,行节段性根尖下戴骨术。80例下颌前突畸形分别采用了SSRO、IVRO、SOM等戴骨术结果300例牙颌面畸形术后外观及功能绝大多数获得了满意的效果。其中术后复发11例,明显复发2例;感觉异常4例;术后感染10例。结论随访结果显示应用AMO,SSRO,IVRO,SOM法矫正牙颌面畸形,获得了满意的效果,并能减少复发,感染和局部感觉异常的发病率。文中就此类手术的术前后正畸、手术方法、手术中注意事项等进行了讨论.     

Pseudoaneurysm of the facial artery occurred after mandibular sagittal split ramus osteotomy

Introduction

Pseudoaneurysms are caused by rupture of arteries with extravasation of blood. The compressed perivascular tissue forms the wall of aneurysmal sac. Pseudoaneurysm directly related with surgical procedure of sagittal split ramus osteotomy (SSRO) was reported quite rarely especially related with facial artery during the vertical osteotomy.

Case report

SSRO was carried out for a 19-year-old male; the patient visited the emergency room with notable swelling 3 weeks after the surgery. We experienced severe intra-oral bleeding with surgical exploration. Angiography revealed a pseudoaneurysm of the right facial artery that might be related with vertical osteotomy over lateral cortex of the mandibular body during orthognathic surgery. This implies that the minor vascular trauma from vertical osteotomy of the mandibular body during the conventional orthognathic surgery might cause later development of pseudoaneurysm.     

Evaluation of condylar resorption rates after orthognathic surgery in class II and III dentofacial deformities: A systematic review

The purpose of this study was to perform a systematic review of morphological alterations in the condyles after orthographic surgery involving a sagittal split ramus osteotomy (SSRO), with or without surgery on the maxilla. Searches were performed on three databases and registered in the PROSPERO. The selected studies fulfilled the criteria established by the following PICO model: (1) population: individuals with skeletal dentofacial deformities (class II or III facial patterns), without asymmetry; (2) intervention: orthognathic surgery for mandibular setback using an SSRO, with or without a Le Fort I osteotomy, and fixed with bicortical screws or plates and screws; (3) comparison: orthognathic surgery for mandibular advancement using an SSRO, with or without a Le Fort I osteotomy, and fixed with plates and screws or bicortical screws; and (4) outcome: condylar resorption rate and relapse. Initially, 1,371 articles were identified and 636 articles were screened after elimination of duplicates, and 6 articles were selected for qualitative analysis based on the inclusion and exclusion criteria. Five studies had data regarding the rate of condylar resorption, varying from 0.0% to 4.2%. In conclusion, condylar resorption and relapses were present in a small percentage of patients studied.     

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)     

不同正颌外科方案对骨性Ⅲ类伴前牙开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类错牙合伴前牙开牙合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类错牙合伴前牙开牙合畸形患者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,观察指标包括覆牙合、下颌平面角、颌间夹角。结果 1）BSSRO+Le FortⅠ与IVRO+ Le FortⅠ组覆牙合显著减小的比率在6、24个月都少于BSSRO与IVRO组。2）BSSRO+Le FortⅠ组与IVRO+ LeFortⅠ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。