正颌外科手术矫治牙颌面畸形的临床回顾性研究

目的对正颌外科手术矫治牙颌面畸形的患者进行临床回顾性研究,以探讨研究牙颌面畸形的术式选择以及对可能出现的并发症预防和治疗。方法通过收集大连市口腔医院口腔颌面外科收治2004年1月～2007年8月牙颌面畸形53例患者,通过对术前术后面型、咬合关系的临床检查、X线头影测量分析,模型外科的设计分析,以对手术疗效进行临床分析和评价。结果53例患者共行手术129例次,术后伤口均I期愈合,面部外形与咬合关系恢复满意;最常见的并发症是下牙槽神经和颏神经的损伤（3/53）,其次是咬合不理想（2/52）,术中出血（1/52）,术后感染（1/52）,其他并发症较少。结论牙颌面畸形患者的外科治疗,要根据牙颌面畸形严重程度,经过临床检查、头影测量分析和模型外科研究得出确切诊断和设计,制定治疗方案,作好术前预测分析,选择合理的手术方案,坚持术前后正畸矫正治疗,才能达到良好咬合关系的效果。     

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。     

正畸正颌联合治疗唇腭裂术后牙颌面畸形的疗效观察

目的:探讨正畸、正颌外科联合治疗唇腭裂术后牙颌面畸形的临床疗效。方法:选择2001—2012年,我院收治的唇腭裂术后牙颌面畸形患者56例,采用正颌联合正畸的方法进行治疗。随访6²4个月,观察牙颌面畸形改善情况。结果:56例患者面形改善明显,咬合关系良好,随访无复发。比较手术前后的头影测量值进行分析,差异具有统计学意义(P<0.05)。结论:正颌外科联合术前、术后正畸,可明显改善面部畸形,减少术后复发,是治疗唇腭裂术后牙颌面畸形的理想手术方式。     

数字化软件在牙颌面畸形正颌术前模拟设计中的应用研究

目的 通过数字化软件对牙颌面畸形患者进行正颌术前模拟设计,将得到的数据应用于临床手术中以指导术者对牙颌面畸形进行精确的手术治疗。方法 选择2012年1月至2013年1月到中国医科大学附属口腔医院口腔颌面外科就诊的牙颌面畸形患者15例,进行术前三维CT扫描,将CT数据输入proplan软件系统中。通过软件重建上下颌骨,在三维方向上对颌骨进行定点、截骨、移动骨段、模拟预测等操作,确定手术方案后保存数据。术中按照软件模拟方案进行手术。结果 15例患者手术顺利,术中未出现严重并发症。术后半年随访,满意率达到93.3%。结论 采用数字化软件对牙颌面畸形患者进行术前模拟设计是一种较为精确的方法,可直观模拟手术并预测术后效果,从而为正颌外科矫治复杂牙颌面畸形制定个体化最佳手术方案提供实用有效的技术和依据。     

《口腔医学研究》杂志2006年第22卷分类索引

口腔颌面解剖、外科治疗289例牙颌面畸形正颌矫治的回顾性研究东耀峻,程波,余世斌等2006,22(1):55稳定型咬合板用于颞下颌关节紊乱病的疗效评价王晟,安钢,胡孝渊2006,22(1):68下颌后缩患者的下颌形态测量研究袁峰,段银钟,马晓萍等2006,22(1):71自体骨膜移植治疗颌骨囊肿的临床观察万克林,周长友2006,22(1):81唇部脉管性疾病治疗的美容效果王秀丽,朱声荣,杨平等2006,22(1):83下颌牵引成骨对下牙槽神经的影响张清彬,东耀峻2006,22(1):99面横动脉在髁状突颈部骨折手术治疗中的临床意义王昭领,黄迪炎,李东临等2006,22(1):62头皮冠状切口治疗颧骨…     

98例唇腭裂患者牙颌面畸形的正畸-正颌外科联合治疗分析

目的 评价正畸-正颌外科联合治疗唇腭裂伴牙颌畸形的效果。方法 回顾分析1990年1月-2000年6月期间在上海第二医科大学和香港大学口腔颌面外科收治的98例唇腭裂伴牙颌面畸形患者，男性52例，女性46例，年龄16—40岁，平均年龄20．5岁。所有患者均在手术前完成正畸治疗，排齐牙列，关闭间隙等。上颌骨手术采用标准化截骨前移手术，伴牙槽裂的患者同期行髂骨取骨植骨术。手术方法包括：①牙槽裂已植骨修复者。采用标准Le fortⅠ型截骨前移术；②牙槽裂未植骨修复的单侧腭裂患者，采用改良上颌骨截骨手术，即非裂侧用Le Fort Ⅰ型截骨术,裂隙侧采用牙槽骨截骨手术(Schuchardt法)，同期行牙槽裂植骨术；③牙槽裂未植骨修复的双侧腭裂患者，采用前颌骨截骨手术(Wunderer法)和双侧上颌骨后份牙槽骨截骨手术(Schuchardt法)，同期行牙槽裂植骨修复术。骨间采用小钛板坚强内固定。随访时间1／2—5a。平均2．6a。结果 术后患者的面型均取得了明显的改善，面部比例协调，咬合关系相对稳定。结论 正畸-正颌外科联合治疗唇腭裂伴牙颌面畸形的效果稳定，应该作为这类畸形治疗的常规方法。     

颌面部骨折错位愈合所致牙颌面畸形的正颌外科治疗

对35例颌面部陈旧性骨折错位愈合所致继发性牙颌面畸形合并严重咬合功能障碍患者，采用正颌外科的原则和方法进行治疗，配合微型钛夹板坚固内固定取得满意疗效。文章就术前准备，手术方法的选择及其注意事项进行了讨论。     

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。     

正颌外科围手术期准备

正颌外科是近几十年来口腔颌面外科和口腔正畸学共同发展所取得的最新成果之一,即通过口腔颌面外科与口腔正畸学的密切结合,共同矫治牙、颌、面畸形,同时解决咬合的问题。它包括牙齿的矫正,也包括颌骨的矫治,使牙、口、颌面功能和形态达到完满、协调和统一。与一般意义上的治病救人概念有所不同,正颌外科一方面使患者的牙、颌功能得到矫治,而另一方面是改善患者的容貌,使患者更加容貌美。所以,面对需要正颌外科矫治的患者,医生必须从以下几方面着手考虑问题。此也是正颌外科围手术期准备的最基本程序。1　常见的牙颌面畸形根据颌骨畸形的受…     

正畸和正颌手术联合矫治牙颌畸形

目的 探讨正畸和正颌手术联合矫治牙颌畸形对于提高疗效、减少复发的临床意义。方法 对４５例牙颌畸形患者术前正畸－正颌手术－术后正畸模式的矫治,并与同期未进行术前、术后正畸的６４例正颌手术病例比较,观察矫澡后的颌面外科、咬合关系及疗效稳定性。结果 正畸和正颌手术联合矫治组治疗后咬合关系良好,咀嚼功能改善率为６２．６％,畸形复发率为２．２％;单纯正颌手术组咀嚼功能改善率为４２．２％,畸形复发率为７．８％     

下颌不对称畸形的正颌外科矫治

目的　探讨正颌手术矫治下颌不对称畸形的方法。方法　对1989年1月~2002年3月收治的110例下颌不对称畸形患者进行分类并对手术方法、疗效进行总结。结果　根据患者不同类型的下颌不对称畸形而采用相应的手术方法,术后均获得良好的口腔功能及面部外形。结论　下颌不对称畸形在确诊发育已停止的情况下,应用正颌手术及结合术前、术后正畸治疗能使下颌不对称畸形获得满意的矫治效果,如畸形发育仍在继续,矫正时应去除异常的生发中心,以免复发。     

正颌手术对颞下颌关节影响的研究进展

正颌术术后的复发往往与颞下颌关节（TMJ）结构和位置异常有关，包括髁突移位、进行性髁突吸收和关节盘移位等。正颌外科作为一种创伤性的手术，对TMJ的结构和位置能产生一定的影响。由于牙颌面畸形患者往往术前即有TMJ的疾病，因此正颌手术本身对TMJ的影响是否导致了复发和产生颞下颌关节紊乱病（TMD）需要多项研究探索。有一些学者提出，正领手术同期行关节盘复位术可提高手术效果稳定性。对预防由于TMJ结构和位置异常引起的复发或TMD，目前临床尚无特定方法。鉴于此，本文将在正颌外科对TMJ结构的影响，与TMD的关系，以及预防术后复发和TMD的方法等三个方面进行综述。     

Thermographic assessment of inferior alveolar nerve injury in patients with dentofacial deformity.

PURPOSE: The purpose of this study was to evaluate the injury and recovery of the inferior alveolar nerve in orthognathic patients at 1 and 4 weeks after surgery using electronic thermography. MATERIALS AND METHODS: Twenty subjects with Class III dentofacial deformity were studied. All patients underwent bilateral sagittal split ramus osteotomy. To image the temperature of the face, 1 anteroposterior view and 1 lateral view were taken from both the right and left sides. Similar images were taken at 1 and 4 weeks after surgery. The control was the presurgical temperature of the 20 patients who showed unilateral or bilateral nerve damage after surgery. RESULTS: In the patients with unilateral nerve damage (n = 14), on the anteroposterior views, the temperatures of the mentum on the 2 sides differed by 0.64 degrees C at 1 week after surgery, and the difference decreased to 0.23 degrees C at 4 weeks after surgery. On the lateral images, the differences in temperature between the mentum areas were 0.10 degrees C at 1 week and 0.27 degrees C at 4 weeks after surgery. In the patients with bilateral nerve injury (n = 6), on the anteroposterior views, the temperatures of the mentum on the 2 sides differed by 0.20 degrees C at 1 week after surgery and 0.13 degrees C after 4 weeks. On the lateral views, the differences were 0.18 degrees C at 1 week and 0.34 degrees C at 4 weeks after surgery. Using the repeated measurement analysis method, the anteroposterior view showed statistically significant results in the patients with unilateral nerve damage. CONCLUSION: The infrared body temperature method is an objective method that can be applied as a supplemental diagnostic method for inferior alveolar nerve injury.     

The clinical relevance of orthognathic surgery on quality of life

The aim of orthognathic surgery is to produce a more aesthetic facial skeletal appearance, and improve jaw function. This prospective study, aimed to evaluate the impact of orthognathic surgery on quality of life for patients with dentofacial deformity, and whether it was clinically meaningful. 62 consecutive patients were recruited (27 male, 35 female) aged 18–38 years. Baseline data were collected using a validated health status measure (Orthognathic Quality of Life Questionnaire (OQLQ)) and a visual analogue scale (VAS). Postoperative questionnaires (OQLQ, VAS) and a Global Transition Scale (GTS) were completed at 6 months after completion of treatment and compared with pre-treatment scores. Following surgery, there was a significant (p < 0.05, paired t test) improvement in OQLQ scores for each domain. The proportion of patients reporting a moderate or large improvement was: facial appearance (93%), chewing function (64%), comfort (60%) and speech (32%). Clinical relevance of change scores was reported in terms of effect sizes, and the largest effect was on facial aesthetics. The clinical impact was moderate on social aspects of deformity and oral function and a small effect on awareness of facial deformity. This research reaffirms that orthognathic surgery has positive effects on quality of life.     

成人骨性安氏Ⅱ类1分类错(牙合)的正颌-正畸联合治疗

目的采用正畸-正颌手术联合治疗骨性安氏Ⅱ类Ⅰ分类错(牙合)患者,介绍手术前后正畸及术前的准备工作.方法11例成人骨性安氏Ⅱ类Ⅰ分类错(牙合)患者,均经术前正畸-正颌手术-术后正畸的治疗过程.手术前后正畸目的是矫正上下颌前牙前突,排齐牙列,协调上下牙弓,平整牙(牙合)曲线,建立正颌术后良好的咬合关系.术前准备包括术前电脑模拟手术、模型外科、(牙合)板制作.结果11例患者建立了良好的咬合关系及协调的上下颌骨关系,面容美观改善.结论骨性错(牙合)畸形患者采用正畸-正颌联合治疗,能获得功能和美观的满意效果,术前正畸、电脑模拟手术、模型外科、(牙合)板制作及术后正畸,每一操作步骤的精确到位均十分重要.     

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。     

Survey of patient experiences of orthognathic surgery: health-related quality of life and satisfaction

The objective of this study was to assess changes in patient quality of life (QoL) after orthognathic surgery at the Kuwait University Dental Clinic. A self-administered Arabic version of the Orthognathic Quality of Life Questionnaire (OQLQ) and two different visual analogue scales (VAS) were used. Sixty-six patients participated (63.6% female). The deformities were corrected by bimaxillary jaw surgery (83.3%), Le Fort I (9.1%), and bilateral sagittal split osteotomy (7.6%). The most important reasons given for undertaking the surgery were facial aesthetics (80.3%) and bite correction (75.8%). Of the patients who had reported moderate to high levels of problems pre-surgery, the majority reported improvements in facial appearance (91.3%), appearance of the teeth (97.0%), biting (96.3%), chewing (92.3%), and eating function (76.5%). Overall, 93.9% of patients reported better conditions after surgery, and the satisfaction level was very high (VAS 91.6%). The VAS score for QoL increased significantly from pre-surgery (73.0%) to post-surgery (93.6%) (P = 0.0001). The OQLQ score was also significantly decreased after surgery, reflecting improvements in the ‘social aspects of dentofacial deformity’, ‘facial aesthetics’, ‘oral function’, and ‘awareness of dentofacial aesthetics’ domains (P = 0.0001). Overall, the patients who underwent orthognathic surgery were satisfied and had improved QoL. The satisfaction rate in the present study reflects successful treatment with orthognathic surgery.     

三维硬组织手术预测和模拟系统在正颌外科手术中的初步应用

目的：基于计算机实现三维颅颌面硬组织手术预测和模拟,探讨其在颌面部复杂畸形治疗中的作用。方法：系统以Windows98为操作平台,采用医学三维可视化技术和Visual C＋＋6．0编程语言编制软件,通过采集患者术前CT原始资料,对8例复杂颌面部畸形患者进行硬组织模型的三维重建以及测量、分析,采用交互方式进行手术模拟,确定手术结果。结果：成功地为8例复杂颌面部畸形患者提供术前诊断,为制定定量化的手术方案提供参考。结论：该系统的建立将为提高复杂颌面部畸形的临床诊断和治疗水平,促进医患的交流与合作发挥作用。     

Condylar atrophy and osteoarthrosis after bimaxillary surgery

Radiographic evidence of condylar atrophy was seen in 12 patients out of 206 patients who underwent surgical orthodontic treatment. All 12 patients had the same dentofacial deformity, high-angle mandibular retrognathia (Class II open bite), and all but one had bimaxillary surgery. The etiologic factors are discussed. The dentofacial deformity is considered to be the main reason for condylar resorption, but orthognathic surgery is supposed to stimulate the progress of the disease by increased loading, disk displacement, and immobilization.     

Condylar changes after orthognathic surgery for class III dentofacial deformity: a systematic review

After orthognathic surgery for class II dentofacial deformity, remodelling of the mandibular condyle will take place. In a number of cases, this may evolve towards a phenomenon of condylar resorption. Yet, studies on the occurrence of this complication after the correction of a class III deformity are scarce. A systematic review of the literature was performed with the aim of identifying reports on condylar resorption or remodelling after orthognathic surgery for class III dentofacial deformity. A search of the international databases yielded 12 eligible studies. Eight studies reported some degree of postoperative condylar remodelling, while symptoms of condylar resorption were only described in a limited group of patients. Thus, the literature may show evidence of condylar remodelling after orthognathic treatment of class III patients, and anecdotal reports of condylar resorption exist. The small sample sizes, heterogeneity in methods and outcomes, and use of two-dimensional radiographs indicate the need for updated long-term research. In the future, the use of cone beam computed tomography data for volumetric and morphological condylar analysis in combination with three-dimensional cephalometry may provide the opportunity to further elucidate this phenomenon and better characterize its aetiology.