Pandit Vikram S, Chang Chun-Shin, Ho Cheng-Ting, Hsu Sam Sheng-Pin, Lin Susie, Liao Han-Tsung
From the Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Linkou Chang Gung Memorial Hospital.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ann Plast Surg. 2019 Dec;83(6):e20-e27. doi: 10.1097/SAP.0000000000002037.
Mandibular prognathism is a common dentofacial deformity in Asia. Treatment of such condition may vary from orthodontic camouflage to surgical orthodontics with orthognathic surgery depending on the severity of the condition. Because of the prominent position of the mandible, fractures involving different locations of the mandible commonly occur in maxillofacial trauma. Anatomical reduction of maxillofacial fractures and restoration of the pretraumatic occlusion are the primary goals of acute management of facial fractures. In patients with dentofacial deformity, simultaneous surgical correction of their malocclusion and improvement of their facial aesthetics while providing open treatment to the maxillofacial fractures are rarely reported in the literature.
We reported 3 cases with combined open reduction and internal fixation and surgery-first orthognathic surgery principles to correct class III malocclusion with mandibular prognathism during acute management of maxillofacial fractures. Computer-assisted surgical simulation was used in surgical planning and fabrication of surgical splint.
Two patients underwent mandibular osteotomies in addition to open reduction and internal fixation of maxillofacial fractures. One patient had both maxillary and mandibular osteotomies during facial fracture repair. Class I occlusion with satisfactory facial profile was achieved in all 3 cases.
Careful patient selection with presurgical planning using computer-assisted surgical simulation is essential in achieving successful outcomes in correcting dentofacial deformities while managing maxillofacial fractures. This combined technique is a viable option in the surgical management of facial fractures in patients with dentofacial deformities.
下颌前突是亚洲常见的牙颌面畸形。根据病情严重程度，此类病症的治疗方法可能从正畸掩饰治疗到正畸正颌手术不等。由于下颌骨位置突出，上颌骨骨折中涉及下颌骨不同部位的骨折较为常见。颌面骨折的解剖复位和创伤前咬合关系的恢复是面部骨折急性处理的主要目标。在牙颌面畸形患者中，同时进行错牙合畸形的手术矫正和面部美观改善，且对面部骨折进行开放治疗的情况在文献中鲜有报道。
我们报告了3例在颌面骨折急性处理期间采用切开复位内固定联合手术优先正颌手术原则来矫正III类错牙合畸形伴下颌前突的病例。手术规划和手术夹板制作中使用了计算机辅助手术模拟。
2例患者除了进行颌面骨折的切开复位内固定外，还接受了下颌骨截骨术。1例患者在面部骨折修复期间同时进行了上颌骨和下颌骨截骨术。所有3例患者均实现了I类咬合关系，面部轮廓令人满意。
在处理颌面骨折的同时矫正牙颌面畸形时，通过计算机辅助手术模拟进行术前规划并仔细选择患者对于取得成功的治疗效果至关重要。这种联合技术是牙颌面畸形患者面部骨折手术治疗的一种可行选择。
