Face Asymmetry and Mandibular Bite Collapse Corrected with Orthognathic Surgery and Miniscrews in a Patient with Wilson's Disease

以正顎手術和迷你骨釘改正威爾森氏症病患的顏面不對稱與下顎咬合塌陷

王依靜(Yi-Chin Wang) ； 柯雯青(Ellen Wen-Ching Ko) ； 陳國鼎(Philip Kuo-Ting Chen)

《中華民國齒顎矯正學雜誌》 24卷2期 (2012/06) Pp. 4-15

https://doi.org/10.30036/TJO.201206.0001

摘要

一位34歲8個月的成年女性，患有隱性遺傳的罕見疾病威爾森氏症（Wilson's disease），呈現不良的咀嚼能力，以及自10年前發病後顏面愈來愈不對稱的情況。我們為她進行了正顎手術搭配齒顎矯正治療，一般術前用來去除齒列代償的齒列矯正部分則盡量減低到最少。不典型的上顎前方根尖下截骨術（maxillary anterior subapical osteotomy）設計關閉上顎前牙原先的牙橋空間，將前上顎骨段往後退，同時盡量維持上顎的牙齒中線。下顎歪斜則以雙側矢向面骨切開術（bilateral sagittal split osteotomies）來改正。雙側後方齒列的嚴重咬合塌陷則有效地以迷你骨釘搭配輔助性的骨皮質切開術（corticotomies）來扶正。文章中討論到治療方式的訂定，正顎手術和矯正治療的過程，以及對威爾森氏症病患在手術方面的特殊考量。

關鍵字

威爾森氏症 ； 正顎手術 ； 迷你骨釘 ； 臼齒扶正

並列摘要

An adult female patient aged 34 years and 8 months with Wilson's disease, a rare autosomal recessive genetic disorder, demonstrated poor chewing ability and facial asymmetry which were worsened gradually since the disease attacked her 10 years ago. She was treated by surgical orthodontics with minimal presurgical orthodontic decompensation. We designed an atypical maxillary anterior subapical osteotomy to close the maxillary incisor pontic space, retract anterior segment of the maxilla, and maintain the dental midline simultaneously. The mandible deviation was corrected by bilateral sagittal split osteotomies. Severe bilateral posterior bite collapses were uprighted effectively and efficiently by miniscrews combined with the adjunctive corticotomies. We also illustrated the decision of treatment modalities, process of orthognathic and orthodontic treatment, and special consideration of surgical approach for this patient and the disease.

並列關鍵字

Wilson's disease ； orthognathic surgery ； miniscrew ； molar uprighting