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骨性畸形在牙颌面畸形中占有相当高的比例,许多患者要通过正颌手术治疗.通常患者首诊到正畸科、颌面外科(整形外科、正颌外科).是否要行正颌手术治疗往往要取决于正畸科是否能通过代偿正畸治疗解决问题.若代偿矫治的结果能使患者和医生都满意,则患者可以避免更复杂、风险更大的正颌手术治疗;若患者的要求很高(可能是美观方面)或畸形非常严重,单纯正畸治疗已不能很好地解决患者对颌面部美观和功能恢复的要求,正颌手术就是惟一正确的选择、目前,在正畸和手术联合治疗开展比较好的医疗单位,是否手术以及手术如何设计几乎是由正畸医生主导.所以,这就要求正畸医生除了要全面掌握骨性牙颌面畸形术前、术后正畸治疗的理论和临床技能外,还要比较透彻地了解各种正颌手术术式、手术的最大限度、术前术后正畸、(牙合)板制作等方面知识.本文将结合临床实际,就几个正畸和手术联合治疗的重要问题进行讨论,重点在各种畸形正颌手术的术式选择策略,正畸和手术联合治疗的术前、术后正畸治疗原则等.

Orthodontic strategy in combined orthodontic and orthognathic therapy for denofacial deformity

The proportion of patients with skeletal malocclusion is high in denofacial deformity,and most of the patients need to be treated with orthognathic surgery.Generally,patients first seek help in orthodontic department,oral and maxillofacial surgery department,such as plastic surgery and orthognathic surgery department.Whether to carry out the orthognathic treatment depends on if the orthodontist is able to solve the problem through orthodontic compensation treatment.If both the patient and the orthodontist are satisfied with the result of the orthodontic compensation treatment,then the patient can avoid suffering from more complex and higher risk of orthognatic surgery.If the patient has a higher request（probably aesthetic aspect） or the deformities are more severe,simple orthodontic treatment can no longer meet the patient＇s needs in facial aesthetics and functional recovery,and then Orthodontic-Orthognathic treatment will be the best choice.Nowadays,in medical institution with more advanced developments in orthodontic-orthognathic treatment,the orthodontist is the main director who determines whether the patient should receive the surgical treatment,and designs the orthognathic surgical procedure.Therefore,the orthodontist is required to grasp comprehensively not only the theories of the skeletal dento-maxillofacial deformities with pre-surgical or post-surgical orthodontic treatment and clinical practice,but also to understand thoroughly the knowledge of different kinds of orthognathic surgical procedures,the maximum use of the surgery,the pre-surgical and the post-surgical orthodontics,and fabrication of surgical wafers.This article combines clinical reality with several discussions of orthodontic-orthognathic treatment.It mainly focuses on the choices of various types of deformities,orthognatic surgical procedure,pre-surgical and post-surgical orthodontic principles of orthodontic-orthognathic treatments and etc.