Hernández-Alfaro F, Mezquida-Fernández C, Brabyn P J, Querejeta-Lomas E, Torres-Gaya J, Valls-Ontañón A
Institute of Maxillofacial Surgery, Teknon Medical Center Barcelona, Barcelona, Spain; Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.
Institute of Maxillofacial Surgery, Teknon Medical Center Barcelona, Barcelona, Spain.
Br J Oral Maxillofac Surg. 2022 Oct;60(8):1102-1107. doi: 10.1016/j.bjoms.2022.04.006. Epub 2022 Apr 26.
The objective of this study was to update and redefine some concepts of the surgery-first (SF) approach, regarding its indications and contraindications, virtual planning work-up, surgical tips, and postoperative orthodontic benefits, after 10 years of experience. A retrospective analysis was made of orthognathic surgical procedures following the SF protocol between January 2010 and December 2019 to review inclusion and exclusion criteria, diagnostic workflow, surgical tips, and postoperative outcomes. A total of 148 SF procedures were performed during this period, which corresponded to only 9.2% of the total orthognathic surgeries performed, which means that we have broadened the exclusion criteria instead of reducing them. Surgical tips include interdental corticotomies solely in cases of anterior crowding and leaving the intermaxillary fixation miniscrews in place postoperatively for orthodontic skeletal anchorage. The mean duration of postoperative orthodontic treatment was reduced in comparison to conventional surgery (36.8 vs 87.5 weeks). The overall degree of satisfaction was high not only for the patients, but also for the orthodontists and surgeon. SF is especially indicated for patients who desire an immediate aesthetic result, with short-term orthodontics, or for treatment of sleep-related breathing disorders, if they meet the established criteria.
本研究的目的是在积累了10年经验之后，更新并重新定义手术优先（SF）方法的一些概念，涉及该方法的适应证和禁忌证、虚拟规划检查、手术技巧以及术后正畸益处。对2010年1月至2019年12月期间遵循SF方案进行的正颌外科手术进行回顾性分析，以审查纳入和排除标准、诊断流程、手术技巧及术后结果。在此期间共进行了148例SF手术，仅占同期正颌手术总数的9.2%，这意味着我们放宽了而非收紧了排除标准。手术技巧包括仅在存在前牙拥挤的情况下进行牙间皮质切开术，以及术后保留颌间固定微型螺钉用于正畸骨骼锚固。与传统手术相比，术后正畸治疗的平均时长缩短了（36.8周对87.5周）。不仅患者，正畸医生和外科医生的总体满意度也很高。如果符合既定标准，SF特别适用于那些期望获得即时美学效果、接受短期正畸治疗或治疗与睡眠相关的呼吸障碍的患者。
