Thüer U, Ingervall B, Vuillemin T
Department of Orthodontics, University of Bern, Switzerland.
Int J Adult Orthodon Orthognath Surg. 1994;9(3):175-85.
The stability and the effect on the soft tissue profile of mandibular advancement with sagittal split osteotomy and rigid internal fixation was studied prospectively in 30 consecutive patients, 17 to 32 years old, who had a distal occlusion. Profile roentgen cephalometric recordings were made immediately before and shortly after surgery as well as 13 months postsurgically. The mean advancement of the mandible 3 to 8 days after surgery was 5 mm. On average, there was only a small increase in the anterior facial height. At the follow-up after 13 months, the advancement of the mandible had, in most cases, partially relapsed so that the median net effect was 70%. In six subjects, however, the mandible had advanced slightly further. The skeletal relapse was partially masked by compensatory movements of the maxillary incisors so that the mean net effect on the overjet was 83%. The amount of relapse was positively correlated to the magnitude of advancement during surgery. Likewise, a postsurgical relapse of the anterior facial height was positively correlated to the magnitude of advancement during surgery. Likewise, a postsurgical relapse of the anterior facial height was positively correlated to the magnitude of the vertical surgical displacement anteriorly and posteriorly. The soft tissue chin closely followed the underlying hard tissue. The mean net effect on the labial fold, however, was smaller, 88% of the mandibular advancement. The net effect on the lower lip was 66% of the advancement of the mandibular incisor.
对30例年龄在17至32岁、存在远中咬合的连续患者进行了前瞻性研究，以探讨矢状劈开截骨术联合坚固内固定进行下颌前徙术的稳定性及其对软组织侧貌的影响。在手术前、手术后不久以及术后13个月分别进行了侧位X线头影测量记录。术后3至8天，下颌平均前徙5毫米。平均而言，面部前高度仅有小幅增加。在13个月的随访中，多数情况下下颌前徙出现了部分复发，因此中位净效果为70%。然而，有6名受试者下颌前徙得稍多一些。上颌切牙的代偿性移动部分掩盖了骨骼的复发，因此对覆盖的平均净效果为83%。复发量与手术中前徙的幅度呈正相关。同样，术后面部前高度的复发与手术中垂直方向前后移位的幅度呈正相关。软组织颏部紧密跟随其下方的硬组织。然而，对唇褶的平均净效果较小，为下颌前徙量的88%。对下唇的净效果为下颌切牙前徙量的66%。
