Boutault F, Cadenat H
Service de Chirurgie Maxillofaciale et Stomatologie, Hôpital Rangueil, Toulouse.
Rev Stomatol Chir Maxillofac. 1992;93(5):287-97.
Even if the functional factors are the most important in the decision, we have always to remember the need of our patient concerning aesthetic improvement. At this moment, the traditional approach based upon morphologic cephalometric analysis (which are frequently discordant) must be substituted by an aesthetic approach. The goal is to obtain a realistic 3D-imaging of the face as it will be after surgery. But it cannot really be achieved yet and we are obliged to work on lateral X-ray cephalograms. The most important at this stage of the decision is not to make a static aesthetic evaluation. It is on the contrary to perform a prospective simulation of the new profile line, as accurate as possible, based upon statistical correlations between soft- and hard-tissues changes. Even if there are some technical problems, even if the results are not currently good enough, the aesthetic prospective analysis allows validation or modulation of the initial functional surgical indication. We can compare for instance the aesthetic results of different amounts of displacements in bimaxillary surgery. Meanwhile, it is sure that the result depends also on the precision of the surgical procedure and on the good functional re-equilibration which is essential for the stability.
即使功能因素在决策中最为重要，我们也始终要记住患者对美学改善的需求。此时，基于形态学头影测量分析（这些分析常常不一致）的传统方法必须被美学方法所取代。目标是获得术后真实的面部三维成像。但目前还无法真正实现，我们不得不依靠头颅侧位X线片开展工作。在决策的这个阶段，最重要的不是进行静态美学评估。相反，要基于软组织和硬组织变化之间的统计相关性，尽可能准确地对新的轮廓线进行前瞻性模拟。即使存在一些技术问题，即使目前结果还不够理想，美学前瞻性分析也能对最初的功能性手术指征进行验证或调整。例如，我们可以比较双颌手术中不同移位量的美学效果。同时，可以肯定的是，结果还取决于手术操作的精准度以及良好的功能再平衡，而功能再平衡对于稳定性至关重要。
