Krekmanov L
Department of Oral Surgery, University of Göteborg.
Swed Dent J Suppl. 1989;61:8-62.
The present series of investigations was performed in order to study the clinical and cephalometric long-term postoperative stability of the maxilla and mandible after surgical correction of jaw abnormities. The patients studied had maxillary or mandibular anomalies, alone or in combination with each other. Standardized surgical methods for correction of jaw deformities were used. Rigid postoperative intermaxillary fixation was omitted in all cases. Masticatory function was recommended immediately after surgery and was increased at the patient's own pace. Patients were able to eat all kinds of food 2-4 weeks postoperatively, independent of type of surgical procedure. The clinical results were good. Intraoperative complications, such as bleeding, unpredictable segment fracture during the splitting procedure, and damage to the neurovascular bundle or roots were negligible. The incidence of postoperative infections was very low. Such infections were limited to the region close to the osteosynthesis material and cleared up as soon as the wires or screws were removed. Paresthesia of the lower lip was seen with the sagittal split procedure especially when it was combined with genioplasty, but disappeared within one year. Standardized pre- and postoperative clinical and roentgenological recordings were made. In order to evaluate the postoperative stability of the osteotomized jaw segments cephalometric analysis of headfilms taken preoperatively, immediately postoperatively and at least one year after surgery was performed. There were no clinically significant postsurgical changes in the position of the maxilla, either in solitary procedures or in bimaxillary corrections. With mandibular advancement the mandible had moved slightly upwards and with setback surgery there was a slight post-surgical forward-upward movement. Omission of postoperative intermaxillary fixation, in combination with swelling or difficulties in nasal breathing, disturbed the tight intercuspidation immediately after surgery. The small changes seen were thought to be the result of tighter inter-cuspidation at the follow-up registration than on the day after surgery.
进行本系列研究是为了探讨颌骨畸形手术矫正后上颌骨和下颌骨的临床及头影测量长期术后稳定性。所研究的患者存在上颌或下颌异常，单独或相互合并存在。采用了矫正颌骨畸形的标准化手术方法。所有病例均未进行术后坚固性颌间固定。建议术后立即开始咀嚼功能训练，并根据患者自身情况逐渐增加训练强度。术后2 - 4周，患者能够食用各种食物，与手术方式无关。临床效果良好。术中并发症，如出血、劈开手术过程中不可预测的节段骨折以及神经血管束或神经根部损伤等均微不足道。术后感染发生率很低。此类感染仅限于靠近骨固定材料的区域，一旦取出钢丝或螺钉，感染就会消除。矢状劈开手术尤其在联合颏成形术时会出现下唇感觉异常，但在一年内会消失。进行了标准化的术前、术后临床及影像学记录。为了评估截骨后颌骨节段的术后稳定性，对术前、术后即刻及术后至少一年拍摄的头颅侧位片进行了头影测量分析。无论是单独手术还是双颌矫正，上颌位置在术后均无临床上显著的变化。下颌前徙时，下颌会轻微向上移动；下颌后退手术时，术后会有轻微的向前向上移动。术后未进行颌间固定，再加上肿胀或鼻呼吸困难，会干扰术后即刻紧密的尖牙对刃关系。观察到的微小变化被认为是随访记录时尖牙对刃关系比术后第一天更紧密的结果。
