Proffit W R, Phillips C, Prewitt J W, Turvey T A
University of North Carolina, School of Dentistry, Chapel Hill 27599-7450.
Int J Adult Orthodon Orthognath Surg. 1991;6(2):71-80.
Nearly half the patients with skeletal Class III malocclusion have maxillary deficiency as the major component of their problem, and modern surgical techniques allow maxillary osteotomy to correct the deformity. Changes at surgery and postsurgically were studied in 49 patients who underwent isolated surgical maxillary advancement. Thirty-one had wire osteosynthesis and maxillomandibular fixation, and 18 had rigid fixation with bone plates. In nearly half the patients, the maxilla was moved down as well as forward, indicating that the patient had both vertical and anteroposterior deficiency. In the anteroposterior plane, 80% of the patients had excellent stability at 1 year, while 20% had 2 to 4 mm of posterior movement of anterior maxillary landmarks. There was no difference in anteroposterior stability between wire/maxillomandibular fixation and rigid internal fixation groups. When the maxilla was moved down as well as forward, there was a strong tendency for relapse upward in both fixation groups. As a result, the chin frequently became more prominent from immediate postsurgery to 1-year followup, as upward movement of the maxilla allowed the mandible to rotate upward and forward.
近半数骨性III类错牙合患者的主要问题是上颌骨发育不足，现代外科技术可通过上颌骨截骨术矫正畸形。对49例行单纯上颌骨前移手术的患者手术中和术后的变化进行了研究。31例采用钢丝骨固定和颌间固定，18例采用骨板坚强内固定。近半数患者上颌骨在向前移动的同时还向下移动，表明患者存在垂直和前后向发育不足。在矢状面上，80%的患者在1年时稳定性良好，而20%的患者上颌前部标志点向后移动2至4毫米。钢丝/颌间固定组和坚强内固定组在矢状面稳定性方面无差异。当上颌骨向前和向下移动时，两组固定方式均有明显的向上复发倾向。因此，从术后即刻到1年随访，由于上颌骨向上移动使下颌骨向上和向前旋转，颏部常常变得更加突出。
