對於骨性異常咬合病患接受雙顎手術治療結果之測顱分析評估

An Assessment of Surgical Outcome of Bimaxillary Surgical Correction of Skeletal Discrepancy

彭月秀(Yueh-Hsiu Peng) ； 林秀雄(Shiu-Shiung Lin) ； 郭安雄(An-Hsiung Kuo)

《中華民國齒顎矯正學雜誌》 17卷2期 (2005/06) Pp. 5-15

https://doi.org/10.30036/TJO.200506.0002

摘要

成年人骨性異常咬合的傳統齒列矯正治療，不易獲得理想的結果。齒列矯正合併正顎手術近年來正被廣泛地使用在治療嚴重的骨骼與齒列差異的異常咬合患者；顏面的美觀及咬合功能的改善，是促使此類患者接受矯正合併手術治療的最大原動力。一般傳統齒列矯正的治療，使其顏面外觀的改變是循序漸進的，而齒列矯正合併正顎手術，則是在短時間內，顏面外觀得到明顯的改變；因此顏面外觀改善的術前預測及術後結果之評估，對於正顎手術治療是極為重要的課題。本研究即應用Henderson's method的測顱X光片及等比例透明膠片之顏面輪廓照片，來評量其照片製作之精準性以及術前預測精準度和治療結果。照片之精確性是以22位具有明顯骨骼差異之齒列不正咬合之成年病患為研究對象，其中17位骨性第三級異常咬合之病人的資料，則應用在評估術前預測之精確度、以及治療結果之改善程度。
結果顯示預測用的照片製作精確度及術前預測之精準度皆令人滿意。術前預測對於標記點的水平方向位移大多準確，在垂直方向位移的預測則傾向於將鼻底置於較實際術後位置較低的部位；而對於下嘴唇標記點，則預測於實際治療後較高的位置。手術前後的測顱分析則顯示，此群骨性第三級異常咬合之病患皆是具備上顎骨後縮合併下顎骨前突之明顯特色；而經由應用上顎LeFortⅠ前移截骨術，合併下顎雙側矢狀劈開後移截骨術，是治療此類骨性第三級異常咬合病人獲得滿意結果的關鍵。

關鍵字

正顎手術 ； 預測 ； Henderson's method ； 骨性差異

並列摘要

The malocclusions associated with significant skeletal discrepancy, for example skeletal Class lll malocclusion, are quite difficult to treat with conventional orthodontics. Recently orthognathic surgery combined with orthodontic treatment to correct facial deformity and severe malocclusion of this type of patients has been performed more frequently. Patients' motivation to have the treatment is mainly due to the desire to improve their facial esthetics. The treatment result tends to influence their attitude of satisfaction. It's therefore important to assess the treatment outcomes of the combined treatment. The cephalometric and photographic study of Henderson's method was evaluated in terms of accuracy of photographic prediction, as well as accuracy of surgical prediction and treatment outcome in 22 non-growing dentate subjects with considerable skeletal dysplasia and 17 adults subgroup with substantial skeletal Class lll malocclusion, separately.
The results showed satisfactory accuracy of photographic duplication, reasonable outcome of surgical prediction, and remarkable post-surgical improvement in both dentoskeletal and facial features. The prediction in Class lll subgroup was generally accurate in horizontal changes. Vertically the planning tended to predict the nasal base more inferior than the actual post-surgical position, and the prediction was likely to place the lower lip landmarks further superior to the actual post-treatment position. The cephalometric analysis of Class lll subgroup revealed the combination of maxillary retrogonathism and mandibular prognathism. The treatment outcome of the same Class lll subjects indicated that both surgical maxillary advancement and mandibular setback contributed to the successful results.

並列關鍵字

prediction ； orthognathic surgery ； Henderson's method ； skeletal discrepancy