Mah Deuk-Hyun, Kim Su-Gwan, Oh Ji-Su, You Jae-Seek, Jung Seo-Yun, Kim Won-Gi, Yu Kyung-Hwan
Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea.
J Korean Assoc Oral Maxillofac Surg. 2017 Feb;43(1):23-28. doi: 10.5125/jkaoms.2017.43.1.23. Epub 2017 Feb 20.
The purpose of this study is to compare the postoperative stability of conventional orthognathic surgery to a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy (BSSRO).
The study included 20 patients who underwent BSSRO for skeletal class III conventional orthognathic surgery and 20 patients who underwent a surgery-first orthognathic approach. Serial lateral cephalograms were analyzed to identify skeletal changes before surgery (T0), immediately after surgery (T1), and after surgery (T2, after 1 year or at debonding).
The amount of relapse of the mandible in the conventional orthognathic surgery group from T1 to T2 was 2.23±0.92 mm (<0.01) forward movement and -0.87±0.57 mm (non-significant, NS) upward movement on the basis of point B and 2.54±1.37 mm (<0.01) forward movement and -1.18±0.79 mm (NS) upward movement on the basis of the pogonion (Pog) point. The relapse amount of the mandible in the surgery-first orthognathic approach group from T1 to T2 was 3.49±1.71 mm (<0.01) forward movement and -1.78±0.81 mm (<0.01) upward movement on the basis of the point B and 4.11±1.93 mm (<0.01) forward movement and -2.40±0.98 mm (<0.01) upward movement on the basis of the Pog.
The greater horizontal and vertical relapse may appear because of counter-clockwise rotation of the mandible in surgery-first orthognathic approach. Therefore, careful planning and skeletal stability should be considered in orthognathic surgery.
本研究旨在比较双侧矢状劈开下颌支截骨术（BSSRO）后传统正颌手术与手术优先正颌方法的术后稳定性。
本研究纳入20例行BSSRO的Ⅲ类骨骼畸形传统正颌手术患者和20例行手术优先正颌方法的患者。分析系列头颅侧位片，以确定术前（T0）、术后即刻（T1）及术后（T2，1年后或拆除矫治器时）的骨骼变化。
传统正颌手术组下颌骨从T1到T2的复发量，以B点为基准，向前移动2.23±0.92 mm（<0.01），向上移动-0.87±0.57 mm（无显著性差异，NS）；以颏前点（Pog）为基准，向前移动2.54±1.37 mm（<0.01），向上移动-1.18±0.79 mm（NS）。手术优先正颌方法组下颌骨从T1到T2的复发量，以B点为基准，向前移动3.49±1.71 mm（<0.01），向上移动-1.78±0.81 mm（<0.01）；以Pog为基准，向前移动4.11±1.93 mm（<0.01），向上移动-2.40±0.98 mm（<0.01）。
手术优先正颌方法中，下颌骨逆时针旋转可能导致更大的水平和垂直复发。因此，正颌手术应考虑仔细规划和骨骼稳定性。
