Clinical Research
Clinical outcomes of combined orthognathic and orthodontic treatment of adult dentomaxillofacial deformity with surgery-first approach
Hu Chao, Wu Guoping, Li Chunlong, Shangguan Wensong, Zhang Wenwen, Wang Shu, Lu Tong, Zhao Yang, Xi Jiri, Qiao Xiang, Jiang Qiaofeng
Published 2020-12-15
Cite as Chin J Med Aesth & Cosmet, 2020, 26(6): 520-524. DOI: 10.3760/cma.j.issn.1671-0290.2020.06.018
Abstract
ObjectiveTo investigate the clinical feasibility and efficacy of combined orthognathic and orthodontic treatment of dentomaxillofacial deformity in adults with surgery-first approach.
MethodsA retrospective analysis was performed on 217 patients with dentomaxillofacial deformity were treated with surgery-first approach from January 2012 to December 2019. Preoperative cephalometric analysis was performed by taking lateral cephalometric images and three-dimensional CT. According to the deformity, Le Fort I maxillary osteotomy, bilateral sagittal split ramus osteotomy, segmental Le Fort I maxillary osteotomy, mandibular subapical osteotomy, and genioplasty were performed to correct the jaw deformity. Postoperative orthodontic treatment was started after a healing period of 2 weeks after the operation.
ResultsIntraoperative mandibular fracture (5 cases, 2.3%), and healed well after intraoperative rigid internal fixation. lower lip numbness (124 cases, 57.1%), the symptoms disappeared in 98 cases and reduced in 26 cases within 3 months, temporary open-bite was observed in 9 cases (4.1%), and diminished by inter-maxillary elastic distraction one month after operation. None of the patients had osteonecrosis, infection, poor wound healing and other complications. All patients completed orthodontic treatment after surgery, and the treatment duration was 6-15 months (average 9.6 months). During the 6-36 months of follow-up, a good facial profile and ideal occlusion were achieved in all patients.
ConclusionsThe surgery-first approach, combined orthognathic and orthodontic therapies, is feasible to treat dentomaxillofacial deformity in adults. With the advantages of earlier improvements in patient facial aesthetics and dental function, the reduction in difficulty and treatment duration of orthodontic management, and increasing patient acceptance. It is regarded as an ideal and valuable alternative for this potentially patients.
Key words:
Dentofacial Deformities; Surgery-first approach; Orthognathic surgery; Malocclusion; Osteotomy
Contributor Information
Hu Chao
Department of Plastic Surgery, the Affiliated Friendship Plastic Surgical Hospital of Nanjing Medical University, Nanjing 210029, China
Wu Guoping
Department of Plastic Surgery, the Affiliated Friendship Plastic Surgical Hospital of Nanjing Medical University, Nanjing 210029, China
Li Chunlong
Department of Plastic Surgery, the Affiliated Friendship Plastic Surgical Hospital of Nanjing Medical University, Nanjing 210029, China
Shangguan Wensong
Department of Plastic Surgery, the Affiliated Friendship Plastic Surgical Hospital of Nanjing Medical University, Nanjing 210029, China
Zhang Wenwen
Department of Plastic Surgery, the Affiliated Friendship Plastic Surgical Hospital of Nanjing Medical University, Nanjing 210029, China
Wang Shu
Department of Plastic Surgery, the Affiliated Friendship Plastic Surgical Hospital of Nanjing Medical University, Nanjing 210029, China
Lu Tong
Department of Plastic Surgery, the Affiliated Friendship Plastic Surgical Hospital of Nanjing Medical University, Nanjing 210029, China
Zhao Yang
Department of Plastic Surgery, the Affiliated Friendship Plastic Surgical Hospital of Nanjing Medical University, Nanjing 210029, China
Xi Jiri
Department of Plastic Surgery, the Affiliated Friendship Plastic Surgical Hospital of Nanjing Medical University, Nanjing 210029, China
Qiao Xiang
Department of Plastic Surgery, the Affiliated Friendship Plastic Surgical Hospital of Nanjing Medical University, Nanjing 210029, China
Jiang Qiaofeng
Department of Plastic Surgery, the Affiliated Friendship Plastic Surgical Hospital of Nanjing Medical University, Nanjing 210029, China
现象，经颌间牵引1个月后开
消失。所有患者均无骨坏死、感染，伤口愈合不良等其他并发症出现；所有患者手术后均完成正畸治疗，治疗周期6～15个月(平均9.6个月)。随访6～36个月，所有患者均获得较为满意的面形和咬合关系，效果满意。
、反
、颌骨大小形态异常等。随着经济、社会的进步，患者有更强烈地矫治畸形的愿望。传统治疗通常包括术前正畸、正颌手术、术后正畸3个阶段，疗效稳定可靠。然而，该方法治疗周期长，常需2年[1]。并且，在术前正畸阶段，牙的去代偿治疗使本不协调的面形和咬合错乱进一步加重畸形，有悖于成人的社交活动与工作生活。近年来，有学者提出术前不做或尽量少做牙齿正畸的手术优先(surgery-first approach, SFA)正颌正畸联合治疗骨性牙颌面畸形的新理念，并逐渐应用于临床实践，取得了满意效果[2]。我们用SFA正颌正畸联合治疗成人骨性牙颌面畸形，取得了满意的治疗效果。
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