正颌-正畸联合治疗下颌偏突颌畸形

目的探讨下颌升支矢状劈开截骨术与正畸联合治疗下颌偏突颌畸形的效果。方法对16例下颌偏突颌畸形患者采用下颌升支矢状劈开截骨术（Hunsanck改进术式），截骨段间采用坚强内固定，尽量减少髁状突的移动范围，并适当延长颌间栓结时间，根据情况及时调整手术前、后正畸治疗方案。结果所有患者面型及黯关系均达到满意效果，患者下颌运动范围在术后3个月时已接近术前水平。在术后6个月随防时未发现有骨性复发和新出现的颞下颌关节症状病例，通过对术前和术后6个月的许勒位X线片测量，发现健侧髁状突12侧（75％）向前移位，患侧髁状突10侧（62．6％）向后移位，这些变化均是在生理范围内的调整。结论在正畸科的配合下，采用改良的下颌升支矢状劈开截骨术是治疗下颌偏突颌畸形的有效方法之一。

Orthognathic surgery-orthogenetic treatment of asymmetric mandibular excess

Objective The purpose of this study is to evaluate the effects of saggital split ramus osteotomy accompanied with orthogenetic approach to treat asymmetric mandibular excess. Methods 16 cases who suffered from asymmetric mandibular excess were received bilateral saggital split ramus osteotomy. The rigid internal fixation was used between segments, Decreasing shift of condyle, suitable prolonging the time of maxillarmandibular fixation and modifying the orthogenetic plan were conducted. Results The appearance and occlusion of all cases had been improved very well after operation. The mandible movement range of all patients got closer to the pre-operation condition in three months post operation. Clinical and X ray examination were made following six months, there are no recurrence and new temporomandibular joint disease in 16 cases. Comparied with pre-operation, most of healthy side moved forward, condyle of abnormal side moved backwards. These changes of condyle were in physiological range. Conclusion With the help of orthogenetic approach, the saggital split ramus osteotomy is one of the best way to treat asymmetric mandibular excess.