利用颌骨塑型技术改善正颌外科手术的美容效果

目的：探讨在正颌外科手术中同期完成下颌骨的塑型手术、上颌骨前壁骨移植或Medpor植入术的可行性。方法：18例女性患者，平均年龄23岁。均诊断为牙颌面畸形，其中下颌前突或伴下颌骨偏斜畸形13例，双颌前突畸形2例，上颌后缩伴下颌前突畸形3例。对上述病例进行正颌外科手术的同时行下颌骨的塑型和（或）上颌骨的骨移植或Medpor植入术、颏成型术。结果：所有病例在术后均出现下唇的麻木，但术后1～6个月下唇感觉恢复正常。无牙齿损伤、伤口感染和骨段坏死发生。经过6～23个月的正畸治疗，均获得良好的咬合关系和协调的面部比例关系及满意的面部轮廓。术后6个月～3年影像检查评估结果表明骨移植成活良好，较少出现骨吸收的现象。结论：在正颌手术的同时进行下颌骨的塑型和（或）上颌骨骨移植或Medpor植入术是可行的，可增加术后面部的美学效果和患者的满意度，同时不增加手术并发症。下颌骨截除的骨质可以用于正颌手术中，避免了其他部位的取骨。

Applying mandibuloplastic technique to improving aesthetic results following orthognathic surgery

Objective：To explore the feasibility of mandibuloplastic surgery or augmentation on the maxilla with autologous bone or Medpor during the orthognathic surgery . Methods： In this series , 18 consecutive patients （females, average age 23） with dentofacial deformities ,were underwent orthognathic surgeries and mandibuloplasti -es, or augmentation on the maxilla with autologous bone or Medpor .Dentofacial deformities were classified as mandi-ble prognathism （ or complicated by mandible deviation ） with classⅢmalocclusions in 13, bimaxillary protusion in 2, maxilla retrusion and mandible prognathism in 3.Results：All patients showed normal sensibility of the lower lip after a 6-month postoperative follow-up, that indicated that inferior alveolar nerve functional was not be affected perpetually.Teeth injury,infection or bone segment necrosis didn′t occur in this series.Normal occlusions were established after the postoperative 6 to 23-month orthodontic treatment in the all patients .Harmonious and attractive facial contours are achieved in the all patients .The grafted bone present less bone resorption in some patients by radiographic assessment after from 6-month to 3-year surgery .Conclusion：The study shows that mandibuloplasty or /and augmentation on the maxilla can be safely performed at the time of orthog-nathic surgery ,and improve the results and the patient′s satisfaction .Moreover , this additional surgeries don′t increase the complication rate .Osseous tissue from mandibuloplastic surgery can be used as bone grafting for orthognathic surgery and it avoids the harvesting bone from other parts .