国际口腔医学杂志 ›› 2020, Vol. 47 ›› Issue (5): 497-505.doi: 10.7518/gjkq.2020090

• 专家笔谈 •    下一篇

外科优先序列治疗——正颌外科的发展热点之一及其误区

王涛()   

  1. 重庆医科大学附属口腔医院颌面外科 重庆市口腔疾病与生物医学重点实验室 重庆 401147
  • 收稿日期:2020-04-08 修回日期:2020-06-30 出版日期:2020-09-01 发布日期:2020-09-16
  • 通讯作者: 王涛
  • 作者简介:王涛,教授,博士,Email: 500077@hospital.cqmu.edu.cn
    专家简介
    王涛,博士,重庆医科大学附属口腔医学院颌面外科教授,博士生导师。里尔第二大学法国国家与健康实验研究中心(French National Institute of Health and Medical Research,University of Lille Ⅱ)博士后,里尔大学Roger Salengro附属医院口腔颌面外科和颅颌面整形中心访问学者兼临床专科医师培训。国际牙医师学院(International College of Dentists,ICD)院士、国际口腔种植学会(International Team for Implantology,ITI)委员、美国微笑列车指定技术培训导师,曾任重庆医科大学口腔医学院口腔颌面外科教研室主任兼颌面外科主任,学科带头人。
    学术成果:参编著作6部,包括参编全国高等院校“十一五”、“十三五”规划研究生统编教材《正颌外科学》、《面裂与唇腭裂》;发表论文50余篇,其中被SCI数据库收录6篇。曾获省部级科研一、二、三等奖各1项(主持加参与),领导的专业临床治疗组曾获美国微笑列车总部颁发的优秀技术奖“International Excellent Standard of Technique”,获国家发明专利1项、国家软件知识产权1项、实用新型专利1项。
    临床专长:1)将“整体平衡头影测量法”引进国内,研究出适合国人的颅颌面特征整体平衡头影测量法,设计开发出基于颅颌面整体平衡理论的头影测量应用软件,获得了国家软件知识产权,广泛应用于正颌外科临床实践中10余年,为颌面畸形整复获得了功能外形双赢的稳定效果,为此积累了丰富的临床经验。2)提出了“柔性正颌外科”的概念和技术,在临床应用于千余例正颌外科手术,大大减少了创伤和并发症,为正颌外科微创化这一难题的突破提供了一定的帮助。3)在颅颌面种植前外科和先天性唇腭裂外科临床工作方面取得了一些进展。
  • 基金资助:
    国家自然科学基金(81600832)

Surgery first approach: one of the hotspots in orthognathic surgery and common problems

Wang Tao()   

  1. Chongqing Key Laboratory of Oral Diseases and Biomedical Science, Chongqing 401147, China
  • Received:2020-04-08 Revised:2020-06-30 Online:2020-09-01 Published:2020-09-16
  • Contact: Tao Wang
  • Supported by:
    National Natural Science Foundation of China(81600832)

摘要:

以矫正牙颌面畸形为主要目标的正颌外科学经过100多年的发展,成了口腔颌面外科一门成熟的分支学科,正颌外科手术已在国内外广泛开展,每年让全世界为成千上万的患者获得了令人满意的牙颌颜面部的功能和外观双赢而且稳定的治疗效果。笔者想通过分析国内外正颌外科学以及相关学科国内外的文献,结合笔者的临床体会讨论目前正颌外科发展的热点之一——外科优先序列治疗的现状和普遍存在的一些误区。

关键词: 正颌外科, 外科优先序列治疗, Delaire整体平衡头影测量法

Abstract:

After more than a century, orthopedic surgery has developed into a mature branch of oral and maxillofacial surgery and has been widely conducted locally and internationally. Tens of thousands of patients worldwide have achieved satisfactory results in the function and appearance of maxillofacial region. This study aims to clarify some common misunderstandings and experiences by analyzing the current situation of surgery first approach model in orthognathic surgery and other related subjects.

Key words: orthognathic surgery, surgical first approach, cranio-facial architectural and structural analysis of Delaire

中图分类号: 

  • R782.2

图 1

典型病例1 A~C:治疗前的面型;D~F:治疗后7个月面型;G:术前的口内咬合关系;H:术后3个月的口内咬合关系;I:术后7个月,去除矫治器后的口内咬合关系。"

图 2

典型病例2的口内外情况 A、B:初诊时的面部情况,面中份发育不足;C、D:掩饰正畸治疗1年后面部情况,反牙合问题已经解决;E、F:“派型”截骨法术后12个月,效果稳定,面中份及鼻翼周围凹陷,下颌前突的症状得到明显改善;G:初诊时的口内情况,反牙合;H:掩饰正畸治疗1年后口内情况,反牙合问题已经解决;I:调整完成的口内牙牙合关系,而牙周也没有进一步损害。"

图 3

典型病例2的影像学情况 A、B:头颅正侧位片术前、术后对比;C~E:术前数字化设计及术后6个月锥形束计算机断层扫描(cone beam computed tomography,CBCT)。"

图 4

典型病例3 A:术前头颅侧位片;B:“整体平衡头影测量”与上下颌骨二维轮廓及牙列重叠影像,示较深的下颌Spee’s曲线,面中份上颌骨前部高度发育不足,与理论咬合平面有一定的差角,直箭头所指;C:实施了BSSRO术后头颅侧位片效果,示咬合关系情况,难以调整,上颌凹陷畸形继续存在,鼻唇角小于90°;D:按“整体平衡头影测量”二维模拟设计比较合理的手术方案(增加了上颌LefortⅠ型截骨加前部植骨,上下颌骨整体向前下旋转,弯箭头所指)。"

图 5

Delaire整体平衡头影测量和正常成年女性颅颌面颈位置及其区域分布示意图"

图 6

Delaire整体平衡头影测量的重叠效应 线条显示该成年女性颌骨的异常形态,重叠后正常个性化应该的位置分布框架,为手术设计提示恢复的正确方向,指导截骨应移动的位置和程度。"

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