Park Ridge, Ill.; New Haven, Conn.; and Philadelphia, Pa.
From Pediatric Plastic and Craniofacial Surgery, Advocate Children's Hospital; the Section of Plastic and Reconstructive Surgery, Yale School of Medicine; the Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and the Division of Plastic Surgery, University of Pennsylvania, Perelman School of Medicine.
Plast Reconstr Surg. 2018 Jun;141(6):925e-936e. doi: 10.1097/PRS.0000000000004438.
After studying this article, the participant should be able to: 1. Identify skeletal differences that are treated with orthognathic surgery; describe the goals of orthognathic surgery; and understand modern virtual surgical planning of orthognathic movement of the mandible, maxilla, and chin. 2. Appreciate the surgical principles of maxilla- versus mandible-first surgery, and orthognathic surgery before orthodontic correction; and understand when an osseous genioplasty may be beneficial, and the potency of this bony movement. 3. Appreciate the utility of fat grafting as an adjunct to orthognathic bony movements, and demonstrate understanding of the utility of orthognathic surgery in the treatment of obstructive sleep apnea. 4. Be aware of associated complications and be able to critically assess outcomes following orthognathic surgery.
This CME article outlines the goals of orthognathic surgery, highlighting advances in the field and current controversies. The principles of the sequencing of osteotomies are discussed and literature is reviewed that may assist in decision-making as to maxilla-first versus mandible-first surgery. The emergence of "surgery first," in which surgery precedes orthodontics, is discussed and important parameters for patient candidacy for such a procedure are provided. The emerging standard of virtual surgical planning is described, and a video is provided that walks the reader through a planning session. Soft-tissue considerations are highlighted, especially in the context of osseous genioplasty and fat grafting to the face. The utility of orthognathic surgery in the treatment of obstructive sleep apnea is discussed. The reader is provided with the most current data on complications following orthognathic surgery and advice on avoiding such pitfalls. Finally, outcome assessment focusing on the most current trend of patient-reported satisfaction and the psychological impact of orthognathic surgery are discussed.
学习本文后，参与者应能够：1. 识别需要正颌手术治疗的骨骼差异；描述正颌手术的目标；并了解下颌骨、上颌骨和下巴的正颌运动的现代虚拟手术规划。2. 欣赏上颌骨与下颌骨手术优先的手术原则，以及正颌术前正畸矫正；并了解何时进行骨性颏成形术可能有益，以及这种骨运动的潜力。3. 了解脂肪移植作为正颌骨运动的辅助手段的效用，并展示对正颌手术在治疗阻塞性睡眠呼吸暂停中的应用的理解。4. 了解相关并发症，并能够对正颌手术后的结果进行批判性评估。
本文概述了正颌手术的目标，强调了该领域的进展和当前的争议。讨论了截骨术顺序的原则，并回顾了可能有助于决策上颌骨手术优先还是下颌骨手术优先的文献。讨论了“先手术”的出现，即手术先于正畸，提供了患者适合此类手术的重要参数。描述了新兴的虚拟手术规划标准，并提供了一个视频，引导读者完成一个规划过程。强调了软组织的考虑，特别是在骨性颏成形术和面部脂肪移植方面。讨论了正颌手术在治疗阻塞性睡眠呼吸暂停中的应用。为读者提供了正颌手术后并发症的最新数据以及避免这些陷阱的建议。最后，讨论了以患者报告满意度为重点的最新趋势和正颌手术的心理影响的结果评估。
