CAJ | 학술논문

目的探讨矫治上颌前突的改进术式,以避免传统术式往往发生的继发鼻部形态改变,并可保证美容效果.方法改进方式是根据下颌前部根尖下骨切开术的原则,在梨状孔下缘下方的前颌骨面、沿各上前牙根尖上3 mm做切骨标志点,将其相连即水平骨切开线,线两端与左右垂直骨切开线相连,呈"小牛角"形,保存梨状孔下缘骨的完整.所有患者通过术前、术后的头影测量侧位X线片,正位像片做临床资料分析.结果 32例患者随访6个月以上,均取得满意的效果,上颌突度和开唇露齿明显改善.经测量分析上唇突度与上颌中切牙突度后退的比值为0.64:1.00.鼻唇角增大15.4.(P＜0.01),人中延长和唇红变薄明显(P＜0.01),鼻尖高度和鼻翼宽度基本无改变(P＞0.05).结论改进的上颌前部骨切开术操作简便,术后美学评价良好,未见发生牙-骨段坏死和继发鼻形态改变并发症,是矫正上颌前突畸形的首选术式之一.
목적 탐토교치상합전돌적개진술식,이피면전통술식왕왕발생적계발비부형태개변,병가보증미용효과.방법 개진방식시근거하합전부근첨하골절개술적원칙,재리상공하연하방적전합골면、연각상전아근첨상3 mm주절골표지점,장기상련즉수평골절개선,선량단여좌우수직골절개선상련,정"소우각"형,보존리상공하연골적완정.소유환자통과술전、술후적두영측량측위X선편,정위상편주림상자료분석.결과 32례환자수방6개월이상,균취득만의적효과,상합돌도화개진로치명현개선.경측량분석상진돌도여상합중절아돌도후퇴적비치위0.64:1.00.비진각증대15.4.(P＜0.01),인중연장화진홍변박명현(P＜0.01),비첨고도화비익관도기본무개변(P＞0.05).결론 개진적상합전부골절개술조작간편,술후미학평개량호,미견발생아-골단배사화계발비형태개변병발증,시교정상합전돌기형적수선술식지일.
Objective The main goals of orthognathic surgery are to achieve funetional occlusion and improve patient's profile.The unintended nasal change in association with anterior maxillary osteotomy is always a challenging.The purpose of this study was to improve the anterior maxillary segmental osteotomy resulting in less post-operative unintended nasal change.Methods Thirty-two patients with maxillary protrusion underwent modified anterior subapical maxillary osteotomy.The design of the modified approach was based on the anterior mandibular subapical osteotomy.The horizontal osteotomy connecting the vertical osteotomy lines on both right and left sides was performed inferior to the piriform aperture and 3 mm over the apex.The integrity of piriform aperture was maximally preserved.Lateral cephalograms,lateral and frontal photographs taken pre-and post-operatively were analyzed.All the patients were followed up for at least 6 months.Results All thirty-two patients were satisfied with esthetic outcome.The upper lip protrusions and tooth exposure improved significantly.Cephalometric and photograph analysis showed that the ratio of upper lip to maxillary ineisor retractionwas 0.64:1.00,and the nasolabial angle and philtrum length were significantly increased(P＜0.05)while vermilion length was decreased.The height of nasal tip and nasal width(alarbase to alarbase)were not significantly changed.Conclusion The modified anterior subapical maxillary osteotomy is a simple procedure leading to no significant postoperative nasal change.It provides a promising alternative in the treatment of maxillary protrusion.