使用改良式口內垂直下顎枝骨切開術將下顎骨後退對正面與側面外觀的變化

Frontal and lateral profile changes following mandibular setback surgery with modified intraoral vertical ramus osteotomy

楊潔(Chieh Yang)

指導教授 ： 曾于娟

高雄醫學大學/口腔醫學院/牙醫學系碩士班/碩士(2017年)

摘要

研究目的：
矯正治療合併正顎手術多為嚴重骨性三級異常下顎前突病患最適合的治療方式，不僅能改善病人的外觀亦改正其咬合功能。術後顏面側面輪廓及周遭軟組織變化的預測值，有助於臨床上治療計畫之擬訂，並藉此應用在術後影像的預測以協助與病人之間治療計畫的討論。此論文為一回溯性的頭顱X光片分析研究，主要為探討使用改良式口內垂直下顎枝切開術將下顎後退後，下臉部軟硬組織及唇部軟組織的術前與術後變化。

材料與方法：
本研究的樣本總數為31位病人（17位女性及14位男性，平均年齡為 20.1歲），皆為下顎嚴重前突，以改良式口內垂直下顎枝切開術使下顎後退來改善臉型及咬合之病患。研究用之側顱X光片及前後向X光片具有良好的拍攝品質，且於以下二個時間點拍攝，分別為T1：術前一個月內、T2：術後一年以上追蹤，以上述之X光片分析下臉部軟硬組織及唇部嘴角手術前後之變化。

結果：
以改良式口內垂直下顎枝切開術後退下顎之後，下顎軟硬組織座標點皆隨著後退，下顎軟組織和硬組織後退變化的比率在ΔSLI /ΔB、ΔPog’/△Pog或ΔMe’ / ΔMe的比值皆很接近1，尤其是 ΔMe’ / ΔMe (1.01)。 嘴角在下顎後向置位手術後是呈現往後、往下及變窄的情況，且嘴角在前後向的後退量約為下顎軟硬組織後退量的一半。

結論：
以改良式口內垂直下顎枝切開術將下顎後退後軟硬組織彼此間移動的關係以及嘴角於術後的變化，皆可作為輔助醫師於臨床治療計畫擬定及與病患溝通之良好參考依據。

關鍵字

骨性三級異常咬合 ； 下顎後退 ； 口內垂直下顎枝切開術

並列摘要

Abstract
Purpose:
Orthodontic treatment combined orthognathic surgery would be the most adequate treatment for the patients with severe Class III skeletal discrepancy, it would not only improve the patients’ profile and also correct their occlusal function. The predictive data about the changes of facial profile and surrounding soft tissue would be an assist in drafting the treatment plan and communication with the patients. This retrospective study using cephalometric radiography combined to evaluate the changes of hard and soft tissue in lower face and commisures of the lips, before and after mandiblular setback using modified intraoral vertical ramus osteotomy (modified IVRO).

Material and method:
Thirty-one patients (17 females and 14 males; mean age：20.1 years) with mandibular prognathism receiving mandibular setback using modified IVRO were recruited in our institution. Lateral and postero - anterior cephalograms were taken respectively at T1: within a month before surgery; and T2 : longer than 1 year after surgery . All the radiographies with good quality to identify the landmarks of the hard and soft tissues in lower faces and soft tissues around the lips

Result:
The soft and hard tissue landmarks of the mandible had backward movements along with the setback surgery of mandible in the horizontal direction. The setback ratios of soft tissue/hard tissue, ΔSLI/ΔB, ΔPog’/ΔPog and ΔMe’ /ΔMe were approached to 1 respectively, especial for the ΔMe’ /ΔMe (1.01). Additionally, the lip commisures had backward, downward and medial movement after mandibular setback surgery, and the backward amount of the lip commisures was almost half of that of the mandibular hard and soft tissue.

Conclusion:
The relationship between the corresponding soft tissue and hard tissue, and the changes of lip commisures after the setback of the mandible with modified IVRO would be a reliable reference basis to establish the treatment plan and patient communication.

並列關鍵字

skeletal Class III jaw relation ； mandibular setback ； intraoral vertical ramus osteotomy

參考文獻

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