Gaszyńska Ewelina, Kozakiewicz Marcin
Uniwersytet Medyczny w Łodzi, Klinika Chirurgii Czaszkowo-Szczekowo-Twarzowej i Onkologicznej.
Pol Merkur Lekarski. 2009 Dec;27(162):474-7.
Therapeutic goals for orthognathic surgery are not only directed towards the correction of dento-osseous deformieties but also to provide the optimal functional and esthetic effect that results in patients satisfaction. THE AIM OF THE STUDY was to evaluate soft tissue changes following surgical treatment of patients with mandibular prognathism operated with two alternative techniques: extraoral vertical ramus osteotomy or sagittal split ramus osteotomy.
A sample of 37 patients with mandibular prognathism operated in Cranio-Maxillofacial Department. The patients included in the study underwent isolated surgery within mandibular rami, without any adjunctive procedures. Long-term and early outcomes of soft tissue changes following surgery were monitored by means of cephalometric analysis according to Arnett in consecutive intervals: before surgical treatment; 1 to 2 weeks after surgery; 6 months and 12 months after surgery. Study variables included age, gender and method of surgical treatment.
In both groups operated with bilateral sagittal osteotomy and extraoral vertical ramus osteotomy methods increase of A'-B' value in T2, T3 i T4 comparing values in T1 was recorded. Immediately and 12 months after both surgeries increase of ULA-LLA, and 6 months after bilateral sagittal osteotomy statistically significant decrease of this parameter compareing with values before surgery was noted. Greater decrease of ULA-LLA value was found from 6 to 12 months postoperatively in female group, final change of ULA-LLA value 12 months after surgery in female group was greater.
Both surgical technics of mandibular setback results in improvement in lower part of the face, although precise analysis of soft tissue profile changes reveals differences. In women skeletal changes caused greater changes within soft tissue than in men.
正颌外科的治疗目标不仅是矫正牙骨畸形，还要提供最佳的功能和美学效果，从而使患者满意。本研究的目的是评估采用两种替代技术（口外垂直升支截骨术或矢状劈开升支截骨术）治疗下颌前突患者手术后的软组织变化。
选取37例在颅颌面外科接受下颌前突手术的患者作为样本。纳入研究的患者仅在下颌升支进行手术，未进行任何辅助手术。根据阿内特头影测量分析法，在连续的时间间隔内监测手术后软组织变化的长期和早期结果：手术治疗前；手术后1至2周；手术后6个月和12个月。研究变量包括年龄、性别和手术治疗方法。
在采用双侧矢状截骨术和口外垂直升支截骨术的两组中，记录到T2、T3和T4期的A'-B'值相对于T1期有所增加。在两次手术后即刻和12个月时，ULA-LLA增加，而在双侧矢状截骨术后6个月，与手术前相比，该参数有统计学意义的下降。术后6至12个月，女性组ULA-LLA值的下降幅度更大，女性组术后12个月ULA-LLA值的最终变化更大。
两种下颌后缩手术技术均能改善面部下部，尽管对软组织轮廓变化的精确分析显示存在差异。女性的骨骼变化在软组织中引起的变化比男性更大。
