Sasaki Ryo, Yao Chuan-Fong, Chen Ying-An, Lin Cheng-Hui, Chen Yu-Ray
Department of Plastic and Reconstructive Surgery, Craniofacial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
J Craniofac Surg. 2016 Jan;27(1):e34-6. doi: 10.1097/SCS.0000000000002301.
It is described in textbook about management of third molar in orthognathic surgery that "ideally, the third molars should be removed 9 to 12 months before sagittal split osteotomy (SSO)." At the Chang Gung Craniofacial Center, the authors always remove mandibular third molars during SSO, because: removal of third molars at the same time of SSO could reduce psychological stress on patients by saving 1 surgical procedure under local anesthesia, better exposure of impacted third molars could be facilitated by sagittal split of buccal cortical plate, rigid fixation could be performed without difficulty by our fixation method using plates and screws crossover anterior oblique line. Strong force during the elevation of third molars, however, may result in the fracture of distal segment of SSO, where the buccal cortical plate is relatively thin because of the presence of third molar. Therefore, more care needs to be taken in the surgical technique, which is different from ordinary tooth extraction. In this paper, the details of surgical procedure of third molar removal during SSO were reported.
正颌外科第三磨牙管理的教科书中描述“理想情况下，第三磨牙应在矢状劈开截骨术（SSO）前9至12个月拔除”。在长庚颅面中心，作者总是在SSO期间拔除下颌第三磨牙，原因如下：在SSO同时拔除第三磨牙可通过节省一次局部麻醉下的手术减少患者的心理压力，颊侧皮质骨板的矢状劈开可便于更好地暴露阻生第三磨牙，使用钢板和螺钉交叉前斜线的固定方法可顺利进行坚固内固定。然而，拔除第三磨牙时的强力可能导致SSO远心骨段骨折，因为第三磨牙的存在，该部位颊侧皮质骨板相对较薄。因此，手术技术需要更加小心，这与普通拔牙不同。本文报道了SSO期间拔除第三磨牙的手术步骤细节。
