Department of Maxillo-Facial Surgery, Policlinico Umberto I, Sapienza University of Rome, Italy.
Eur Rev Med Pharmacol Sci. 2012 Oct;16(10):1430-2.
Indications for treatment of patients with maxillo-mandibular malformations have to be researched both in the severity of anatomical alteration affecting the face and psychological outcomes. Indeed, it has been underlined that patients decide to undergo orthodontic and orthognathic procedure mainly for aesthetical issues. Moreover the early combined functional and surgical treatment improves relationship skills in young adults. Dealing with these "aesthetic" features pre surgical planning presents some additional challenges. Even if orthognatic surgery aims to the correct repositioning of skeletal bases but we must achieve complete patient satisfaction.
The Authors present a new parameter to be considered in the planning of patients who undergo orthognatic procedure being the restitution of the face the patient would have had without any pathologic mechanism with respect of the aesthetic features of the family.
Authors identified a series of parameters discussed by Arnett et al and performed a clinical and photographic evaluation of these parameters, in latero-lateral view, directly on the relatives of the patients. A cephalometric analysis, was performed and a series of parameters has been taken into account.
It is very difficult to standardize universal parameters acceptable and applicable for every single case, considering that patient's awareness of the anatomical defect and post-surgical satisfaction don't relate to the correct cephalometric evaluation and the real aesthetic outcomes.
治疗上下颌骨畸形患者的适应证不仅要考虑到对面部解剖结构改变的严重程度,还要考虑到心理结果。事实上,已经有人强调,患者决定接受正畸和正颌手术主要是出于美学问题。此外,早期联合功能和手术治疗可以提高年轻成年人的社交能力。在术前规划中处理这些“美学”特征会带来一些额外的挑战。尽管正颌手术的目的是正确复位骨骼基础,但我们必须使患者完全满意。
作者提出了一个新的参数,用于规划接受正颌手术的患者,该参数是恢复患者在没有任何病理机制的情况下的面部特征,相对于家族的美学特征。
作者确定了 Arnett 等人讨论的一系列参数,并对这些参数进行了临床和摄影评估,直接对患者的亲属进行了侧位视图评估。进行了头影测量分析,并考虑了一系列参数。
考虑到患者对解剖缺陷的认识和术后满意度与正确的头影测量评估和真实的美学结果无关,很难为每个病例制定可接受和适用的通用参数。