Department of Plastic and Reconstructive Surgery, Ulsan University College of Medicine, Seoul Asan Medical Center, Seoul, South Korea.
Department of Plastic and Reconstructive Surgery, Ulsan University College of Medicine, Seoul Asan Medical Center, Seoul, South Korea.
J Craniomaxillofac Surg. 2021 Jun;49(6):435-442. doi: 10.1016/j.jcms.2021.04.005. Epub 2021 Apr 20.
We aimed to compare the reliability of the surgery-first approach and the traditional orthodontic-first approach for the correction of facial asymmetry based on the new classification of facial asymmetry. Patients with facial asymmetry who underwent orthognathic surgery between January 2016 and January 2019 were included. Cephalometric changes and relapse ratios were analyzed 12 months before and after surgery. Patients were divided into horizontal and vertical asymmetry groups based on the asymmetry vector, and subgroup analysis was conducted. The surgery-first approach without presurgical orthodontic treatment and the orthodontic-first approach showed a similar degree of asymmetry correction and skeletal stability. The relapse ratios of the maxilla height in the surgery-first and orthodontic-first groups were 0.25 ± 0.21 and 0.27 ± 0.25, respectively (p = 0.63), the relapse ratios of the maxilla width were 0.31 ± 0.32 and 0.21 ± 0.2, respectively (p = 0.14), the mandibular height relapse ratios were 0.34 ± 0.58 and 0.29 ± 0.36, respectively (p = 0.69), and the mandibular width relapse ratios were 0.12 ± 0.22 and 0.26 ± 0.31, respectively (p = 0.058). The treatment period of the surgery-first group (18.5 ± 5.3 months) was significantly shorter than that of the orthodontic-first group (22.9 ± 7.5 months, p = 0.024). Among the surgery-first group, patients with vertical asymmetry (15.0 ± 3.2 months) had a shorter treatment than those with horizontal asymmetry (21.6 ± 6.8 months, p = 0.006). Although contesting traditional standards is always challenging, the surgery-first orthognathic approach may lead to a new era in traditional orthognathic approaches. This new classification of facial asymmetry could be useful and practical when treating patients with facial asymmetry regardless of the etiology.
我们旨在比较基于新的面部不对称分类的手术优先方法和传统正畸优先方法在纠正面部不对称方面的可靠性。纳入 2016 年 1 月至 2019 年 1 月间接受正颌手术的面部不对称患者。分析手术前 12 个月和手术后的头影测量变化和复发率。根据不对称向量将患者分为水平和垂直不对称组，并进行亚组分析。无术前正畸治疗的手术优先方法和正畸优先方法显示出相似程度的不对称矫正和骨骼稳定性。手术优先组和正畸优先组上颌高度的复发率分别为 0.25±0.21 和 0.27±0.25（p=0.63），上颌宽度的复发率分别为 0.31±0.32 和 0.21±0.20（p=0.14），下颌高度的复发率分别为 0.34±0.58 和 0.29±0.36（p=0.69），下颌宽度的复发率分别为 0.12±0.22 和 0.26±0.31（p=0.058）。手术优先组的治疗期（18.5±5.3 个月）明显短于正畸优先组（22.9±7.5 个月，p=0.024）。在手术优先组中，垂直不对称（15.0±3.2 个月）患者的治疗期短于水平不对称（21.6±6.8 个月，p=0.006）。尽管挑战传统标准总是具有挑战性，但手术优先的正颌方法可能会开创传统正颌方法的新时代。无论病因如何，这种新的面部不对称分类在治疗面部不对称患者时可能是有用且实用的。
