双颌畸形同期外科矫治术48例报道

Simultaneous bimaxillary orthognathic surgery for correction of bimaxillary deformities:Report of 48 cases

目的:总结分析同期手术矫治双颌畸形的手术设计与效果。方法:对48例累及上、下颌骨的牙颌面畸形患者进行同期双颌手术。其中上颌后缩、下颌前突17例,同时伴有偏颌畸形5例;上颌前突、下颌后缩9例;双颌前突13例;腭裂术后上颌后缩2例;长面综合征2例。全部病例均按规范正颌手术诊治程序进行。手术设计依畸形类型而定,基本术式为:上颌骨行整体或分块的LeFortⅠ型骨切开术,同期行双侧下颌支矢状骨劈开术(SSRO)或垂直骨切开术(IVRO);上颌前部骨切开配合下颌前部根尖下骨切开术;部分病例配合颏成形术。结果:48例患者伤口一期愈合,无感染及骨段坏死,术中及术后并发症共7例,均得到及时处理,未影响最终结果。术后随访6～36个月显示,除2例复发外,其余病例外形及功能均达到术前预期效果。结论:随访结果显示,严格按照规范的诊治程序,采用外科与正畸相结合的方式,有针对性地设计并行双颌同期手术,有诸多优点,是取得功能与形态俱佳效果的最佳选择。

PURPOSE: To Summarize our experience in simultaneous bimaxillary orthognathic surgery for correction of bimaxillary deformities. METHODS: Forty-eight subjects with bimaxillary deformities underwent simultaneous bimaxillary orthognathic surgery to correct deformities. Total maxillary LeFortⅠosteotomy or anterior maxillary osteotomy , bilateral sagittal split ramus osteotomy (SSRO) or intraoral vertical ramus osteotomy (IVRO), or genioplasty were applied in combination to correct deformities, including mandibular prognathism with maxillary deficiency, maxillary prognathism with mandibular deficiency, bimaxillary protrusion, maxillary deficiency resulting from cleft palate and long-face syndrome. Rigid internal fixation was used when necessary. RESULTS: Most of the cases acquired the appearances and function as designed pre-operatively. One developed mandibular fracture and one had inferior alveolar nerve injury. The clinical follow-up period ranged from 6 to 36 months . 2 cases had relapse. CONCLUSION: Satisfying effects could be achieved for bimaxillary deformities when proper bimaxillary orthognathic surgical procedures were applied.