牙颌面畸形患者手术前后生活质量变化研究

目的    评估牙颌面畸形患者正颌手术前后口腔健康相关生活质量的变化,为临床方案制定和医患沟通提供参考。方法    选择2019年6—12月于中国医科大学附属口腔医院口腔颌面外科接受正颌手术的牙颌面畸形患者35例作为研究组,100名健康正常人作为对照组,以正颌手术生活质量问卷（OQLQ）对患者手术前后口腔健康相关生活质量进行评估。结果    牙颌面畸形患者的口腔功能、面部美学、牙颌面美学感知以及社会因素的术后评分均低于术前（P < 0.001）,术前评分均高于对照组（P < 0.001）;术后牙颌面美学感知和社会功能的评分高于对照组（P < 0.05）。结论    牙颌面畸形患者正颌手术术前的口腔健康相关生活质量低于正常群体,术后各维度比术前均明显改善,但术后牙颌面美学感知和社会功能方面的生活质量仍低于正常人群。     

正颌患者生存质量评估研究现状

生存质量受个人健康状况、心理状态、独立程度、社会关系以及所处环境等因素影响,由患者主导的生存质量评价越来越受到重视。牙颌面畸形患者不仅表现为口颌功能障碍,还存在不同程度的社交恐惧、性格缺陷等一系列心理问题,临床上则主要通过正颌手术改善患者形貌与口颌功能,但缺乏全面的生存质量评估体系。目前,与口腔健康相关的测评方法广泛用于牙颌面畸形患者生存质量的评估研究,较全面反映正颌手术对患者生存质量的影响。本文就正颌患者生存质量的评估研究现状作一综述。     

应用计算机面像预测系统评价正颌手术效果

应用计算机面像预测系统对正颌手术效果评价。方法 ２４例牙颌面畸形患者在正颌手术前运用计算机面像预测系统作模拟手术，得到了模拟手术预测分析后的与预测面像，与术后实际的Ｘ线头颅定位片及彩色面像作比较。结果 预测像与实际软组织像除了下区域各方面都非常相似。     

牙颌面畸形正颌手术的护理配合

目的　探讨如何加强牙颌面畸形正颌手术护理配合 ,确保手术成功的措施。方法　总结 5 0例牙颌面畸形患者的正颌手术。上下颌骨同时截骨 16例 ,单纯上颌骨或下颌骨截骨 34例 ,均行细致的术前准备和熟练的手术配合。结果　 5 0例正颌外科手术 ,手术时间最长 6h ,最短 2h ,均获得满意的手术效果。结论　牙颌面畸形正颌手术技术要求高且需特殊器械 ,手术前的准备工作及手术中熟练的配合是保证手术顺利进行的重要因素。     

下颌优先于双颌正颌手术中运用的研究进展

目前有两种常用的双颌正颌手术顺序:上颌优先和下颌优先.上颌优先即先行上颌骨截骨、定位和固定,再行下颌截骨,通过已固定的上颌定位下颌的位置;下颌优先则反之,以下颌骨的截骨、定位和固定为先,再行上颌手术.有研究发现下颌优先相比上颌优先具有很多优点,但上颌优先和下颌优先的运用范围和术后效果等方面仍存较多争议.本文就下颌优先的...     

正颌外科手术后的牵引原则

目的:对各类牙颌面畸形患者正颌手术完成后行安氏、、类牵引的重要性予以讨论分析。方法:24例各类牙颌面畸形患者正颌术后进行了安氏、、类牵引。结果:经术后安氏、、类牵引后,术后3～6月手术效果稳定,为术后正畸进一步的建,提供了良好的条件。结论:牙颌面畸形正颌手术后,由于功能和肌张力的改造往往落后于畸形的改造,易致畸形的复发,术后牵引可帮助肌肉系统的改建,建立新的平衡机制,确保美观和功能的一致。     

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。     

正颌手术配合15枚牙种植体即刻修复1例

牙颌面畸形患者合并有牙缺失，在行正颌外科手术治疗的同时，常常配合义齿修复来恢复其形态和功能，种植义齿修复就是其中较好的一种形式。我科收治一例患者，在行正颌手术同时，配合15枚种植义齿即刻修复，取得良好效果，现报道如下。     

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.     

“手术优先”正颌正畸治疗成人骨性牙颌面畸形的研究进展

传统正颌正畸治疗成人骨性牙颌面畸形包括术前牙齿矫正、正颌手术和术后牙齿矫正,具有适应证范围广、治疗效果明确可靠等优点。然而,这一传统治疗方式也存在治疗周期较长和因术前去代偿所致的暂时性面容丑化等不足。近年来,“手术优先”正颌正畸治疗理念（即先进行正颌手术然后进行正畸治疗）被学者提出并逐步应用于临床实践。该文就其基本理念、临床应用及优缺点等方面作一综述。     

Assessing the Quality of Life in Patients With Dentofacial Deformities Before and After Orthognathic Surgery

1. Download high-res image (228KB)
2. Download full-size image

     

289例牙颌面畸形正颌矫治的回顾性研究

目的:对正颌手术矫治牙颌面畸形的患者进行回顾性研究,探讨牙颌面畸形的分类、手术方式的选择与并发症的防治。方法:收集1985~2003年武汉大学口腔医学院口腔颌面外科收治的牙颌面畸形病例中,资料较完整的289例作回顾性分析,通过术前术后面型、咬合关系、颞下颌关节功能的临床检查、X线分析及下牙槽神经功能评测,对手术疗效进行评价。结果:289例患者共行手术449例次,282例(282/289)术后伤口I期愈合,其余7例延期愈合,面型与咬合恢复满意;最常见的并发症是下牙槽神经损伤(12/289),其次是咬合不理想(10/289),其他并发症较少。结论:牙颌面畸形患者的外科治疗,要根据个体畸形情况和要求,经过专科临床检查、头影测量分析和模型研究得出确切诊断和设计,拟定治疗方案作好术前预测,选择合适正颌手术,坚持术前术后正畸,方能重建牙颌面结构的关系和咬合功能的效果。     

The Early Psychological Adjustment of Cleft Patients After Maxillary Distraction Osteogenesis and Conventional Orthognathic Surgery: A Preliminary Study

PURPOSE: To compare the early psychological changes of cleft lip and palate (CLP) and noncleft patients after maxillofacial corrective surgery, including maxillary distraction osteogenesis and conventional orthognathic surgery. MATERIALS AND METHODS: Nine CLP patients were compared with a group of 9 non-CLP patients having similar dentofacial deformities in a prospective longitudinal cohort study. Five of the CLP patients underwent maxillary distraction osteogenesis and 4 underwent conventional orthognathic surgery. A control group of 9 noncleft patients received conventional orthognathic surgery. All patients completed a set of questionnaires to enable their psychological profile to be assessed. The data were collected immediately before surgery (T1), and at 3 weeks (T2) and 12 weeks (T3) after surgery. RESULTS: The CLP patients treated with distraction osteogenesis were happier, but had a higher level of social anxiety and distress than the CLP patients receiving conventional orthognathic surgery. On the other hand, the CLP patients overall were happier, with lower social anxiety and distress, than the noncleft control group. The CLP patients showed a higher level of parental self-esteem than the noncleft patients. CONCLUSION: This preliminary study shows that CLP patients were generally happier, and had a higher level of parental support, than normal patients suffering from dentofacial deformities. Maxillary distraction osteogenesis seemed to induce a higher level of anxiety and distress in CLP patients than conventional orthognathic surgery in both cleft and noncleft patients.     

Perceptions of Pre- to Postsurgical Profile Changes in Orthognathic Surgery Patients and Their Correlation with Photogrammetric Changes: A Panel Study

Purpose

The objective was to compare the pre- and postsurgical profile changes after surgical correction of prognathism and maxillary hypoplasia, as perceived by panels of orthodontists, maxillofacial surgeons, laypersons and patients and to identify photogrammetric changes that might be related to preferred ratings.

Materials and methods

Each panel consisted of six males and six females who rated sets of pre- and postsurgical lateral photographs of 20 female and 20 male patients using a five-point scale. Patients rated their own set of photographs. Pre- to postsurgical differences of photogrammetrically assessed landmarks were recorded as a surgical change.

Results

No significant differences in ratings between panels and patients could be detected. Significant correlation coefficients (r) were obtained between the ratings of all panel groups and between the ratings and changes in facial convexity (r = 0.351–0.542). Correlations with changes of the mentolabial angle were found to be significant for old orthodontists, male laypersons, and male patients (r = 0.332–0.609). Ratings of female and young laypersons were correlated with the horizontal changes in the lower face (r = 0.324–0.379).

Conclusion

Information gathered from this study will support the cooperation of the medical staff and might assist in treatment planning.