口内路径下颌骨升枝矢状劈开截骨术治疗下颌前突畸形

INTRAORAL SAGITTAL SPLIT RAMUS OSTEOTOMY FOR MANDIBULAR PROGNATHISM

下颌骨升枝矢状劈开术是目前世界上使用最普遍的矫正下颌骨畸形的手术方法之一。作者采用口内入路下颌骨畸形的手术方法之一。作者采用口内入路下颌骨升枝矢状劈开截骨术治疗下颌骨前突１８２例，其中真性下颌前突１４３例，假性下颌前突３９例。年龄在１５～５８岁之间，平均２４岁。随访６个月～９年。除９例术后畸形复发需再次矫正以外均获满意效果。本文介绍了口内入路下颌骨升枝矢状截骨术的手术过程及注意事项，并着重讨论了其优缺点。

Clearly the intraoral split osteotomy of the ascending ramus is one of the most popular method for the surgical correction of mandibular prognathism.One hundred eighty two patients suffering from mandibular prognathism have been operated on by the intraoral sagittal split ramus osteotomy(SSRO).The group of patients include 143 cases of truly prognathism and 39 cases of false prognathism,ranging in age from 15 to 58 years(the mean age:24 years). All patients are given nasotracheal anesthesia.The intraoral incision is made along the external oblique ridge from about half way up the ascending ramus inferiorly to the region of the first molar.A full-thickness mucoperioteal flap is raised.Osteotomy regions are well exposed and the inferior alveolar neurovascular bundle is identified and protected after the careful dissection.Osteotomy mark is made clearly with ink and the osteotomy is beginning at the external cortex.Sagittal split osteotomy of the mandible is made and the cut of the external cortex is completed dependent upon the study before operation.As now,the mandible is to be set back.After examination of the dental articulation and the position of the condyle in the fassa,the mini-plates are placed intraoral and attached with monocortical screws in the juxta-alveolar area.After closing the incision,the occlusion is checked and selective reshaping of the teeth is performed if it is necessary. The principal complications of these patients are 3 cases postoperative infection,2 case mandibular fracture during the clivage of the ramu,6 cases disorder of local sensibility and 1 case of significance bleeding.These 182 patients were following routinely with a minimum follow-up of 6 months and a maximum follow-up of 9 years.All the patient has a good result except 9 cases of relapse necessitating a second surgical correction. The intraoral sagittal split ramus osteotomy(SSRO) permits the stability of the dental occlusion,the mandible and the craniomaxillar joint,the maintenance of integrity of the neurovascular bundle and offers a widely surface of contact of the osteotomied segment.The long-term result shows that the SSRO for the surgical correction of mandibular prognathism is a better method which may promote more rapid healing of the bone,allow early restoration of function and reduce incidence of infection and relapse and after all,obtain a greater satisfaction for our patients and surgeons.