改进的上颌前部骨切开术矫治上颌前突及其术后的美学评价

目的 探讨矫治上颌前突的改进术式,以避免传统术式往往发生的继发鼻部形态改变,并可保证美容效果.方法 改进方式是根据下颌前部根尖下骨切开术的原则,在梨状孔下缘下方的前颌骨面、沿各上前牙根尖上3 mm做切骨标志点,将其相连即水平骨切开线,线两端与左右垂直骨切开线相连,呈"小牛角"形,保存梨状孔下缘骨的完整.所有患者通过术前、术后的头影测量侧位X线片,正位像片做临床资料分析.结果 32例患者随访6个月以上,均取得满意的效果,上颌突度和开唇露齿明显改善.经测量分析上唇突度与上颌中切牙突度后退的比值为0.64:1.00.鼻唇角增大15.4.(P＜0.01),人中延长和唇红变薄明显(P＜0.01),鼻尖高度和鼻翼宽度基本无改变(P＞0.05).结论 改进的上颌前部骨切开术操作简便,术后美学评价良好,未见发生牙-骨段坏死和继发鼻形态改变并发症,是矫正上颌前突畸形的首选术式之一.

Esthetic evaluation after modified anterior segmental osteotomy on maxillary protrusion

Objective The main goals of orthognathic surgery are to achieve funetional occlusion and improve patient's profile.The unintended nasal change in association with anterior maxillary osteotomy is always a challenging.The purpose of this study was to improve the anterior maxillary segmental osteotomy resulting in less post-operative unintended nasal change.Methods Thirty-two patients with maxillary protrusion underwent modified anterior subapical maxillary osteotomy.The design of the modified approach was based on the anterior mandibular subapical osteotomy.The horizontal osteotomy connecting the vertical osteotomy lines on both right and left sides was performed inferior to the piriform aperture and 3 mm over the apex.The integrity of piriform aperture was maximally preserved.Lateral cephalograms,lateral and frontal photographs taken pre-and post-operatively were analyzed.All the patients were followed up for at least 6 months.Results All thirty-two patients were satisfied with esthetic outcome.The upper lip protrusions and tooth exposure improved significantly.Cephalometric and photograph analysis showed that the ratio of upper lip to maxillary ineisor retractionwas 0.64:1.00,and the nasolabial angle and philtrum length were significantly increased(P＜0.05)while vermilion length was decreased.The height of nasal tip and nasal width(alarbase to alarbase)were not significantly changed.Conclusion The modified anterior subapical maxillary osteotomy is a simple procedure leading to no significant postoperative nasal change.It provides a promising alternative in the treatment of maxillary protrusion.