Jeong Woo Shik, Choi Jong Woo, Kim Do Yeon, Lee Jang Yeol, Kwon Soon Man
Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea.
Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea.
Int J Oral Maxillofac Surg. 2017 Apr;46(4):473-482. doi: 10.1016/j.ijom.2016.12.006. Epub 2016 Dec 30.
Although pre-surgical orthodontic treatment has been accepted as a necessary process for stable orthognathic correction in the traditional orthognathic approach, recent advances in the application of miniscrews and in the pre-surgical simulation of orthodontic management using dental models have shown that it is possible to perform a surgery-first orthognathic approach without pre-surgical orthodontic treatment. This prospective study investigated the surgical outcomes of patients with diagnosed skeletal class III dentofacial deformities who underwent orthognathic surgery between December 2007 and December 2014. Cephalometric landmark data for patients undergoing the surgery-first approach were analyzed in terms of postoperative changes in vertical and horizontal skeletal pattern, dental pattern, and soft tissue profile. Forty-five consecutive Asian patients with skeletal class III dentofacial deformities who underwent surgery-first orthognathic surgery and 52 patients who underwent conventional two-jaw orthognathic surgery were included. The analysis revealed that the total treatment period for the surgery-first approach averaged 14.6 months, compared with 22.0 months for the orthodontics-first approach. Comparisons between the immediate postoperative and preoperative and between the postoperative and immediate postoperative cephalometric data revealed factors that correlated with the total treatment duration. The surgery-first orthognathic approach can dramatically reduce the total treatment time, with no major complications.
尽管在传统正颌治疗方法中，术前正畸治疗已被视为稳定正颌矫治的必要过程，但微型螺钉应用及利用牙模进行正畸治疗术前模拟的最新进展表明，不进行术前正畸治疗而采用手术优先的正颌治疗方法是可行的。这项前瞻性研究调查了2007年12月至2014年12月期间接受正颌手术的诊断为骨骼Ⅲ类牙颌面畸形患者的手术效果。对采用手术优先方法的患者的头影测量标志点数据进行了分析，涉及术后垂直和水平骨骼模式、牙模式及软组织侧貌的变化。纳入了45例连续接受手术优先正颌手术的亚洲骨骼Ⅲ类牙颌面畸形患者以及52例接受传统双颌正颌手术的患者。分析显示，手术优先方法的总治疗期平均为14.6个月，而正畸优先方法为22.0个月。术后即刻与术前以及术后与术后即刻头影测量数据的比较揭示了与总治疗时长相关的因素。手术优先的正颌治疗方法可显著缩短总治疗时间，且无重大并发症。
