精品牙颌面畸形小讲课蔡鸣_ 吉林工商学院报 课件

Dental-facial Deformities Cai Ming Dept. of OMS, Shanghai 9th peoples hospital, Jiao tong University Orthognathic Surgery Definition Classification Treatment plan CLASSIFICATION Vertical Sagittal Transverse Bimaxillary Asymmetric Hyperplasia Hypoplasia AngleAngle分类分类 Angle 正常 Angle 错 Angle 错 Angle 错 下颌后缩或 上颌前突 上颌后缩或 下颌前突 ETIOLOGY Congenetial Acquired EXAMINATION History Clinical finding Laboratory LaterallyFrontally Teeth Dental Mouth opening TMJ X-Ray Model Photographic Cephelometric Analysis 1. 硬组织测量标志点 颅部蝶鞍点（S） 鼻根点（N） 机械耳点(P) 上颌骨前鼻棘(ANS) 上齿槽座点（A） 上中切牙点（U1） 下颌骨下齿槽座点（B） 下中切牙点（L1） 颏前点（Pg） 颏下点(Me) 颏顶点(Gn) 额点（G） 鼻小柱点（Cm） 鼻下点（Sn） 上唇缘点（UL） 下唇缘点（LL） 软组织颏前点(Pgs) 软组织颏下点(Mes) 颈点（C） 2. 软组织测量标志点 Reference Plane and Angel CaseCase SNA78 SNB85 ANB 7 S N A B S N A B SNA76 SNB70 ANB 6 Treatment Plan Examination Diagnosis Joint orthognathic & orthodontic assessment Presurgical Orthodontics Postsurgical Orthodontics Surgical Plan Orthognathic Surgery Objective of Presurgical Orthodontic Decompansation (angulation teeth, accentuate deformities) Alignment Compatibility PREPARATION Caries & Peridontal disease Visal treament objective Model surgery Computer aided analyze VTO SURGICAL TREAMENT PHASE Maxilla Mandible Maxillary segmental osteotomy (Anterior / Posterior) Indications: - maxillary protrusion - marked protrusion of maxillary teeth - open bite Le Fort I osteotomy (total or segmental) Indications: - maxillary deformities - mandibular deformities 常用正颌外科截骨线常用正颌外科截骨线- - Le fort I osteotomyLe fort I osteotomy Le Fort II or III osteotomy Indications: - midface deficiency Sagittal split ramus osteotomy, SSRO Indications: - mandibular excess - mandibular deficiency - mandibular asymmetry Adback rotate Vertical ramus osteotomy Indications: - mandibular excess - mandibular asymmetry (combined with SSRO) back Subapical osteotomy Indications: - bimaxillary protrusion / open bite - leveling the plane of occlusion - uprighting anterior teeth Body osteotomy Indications: - mandibular excess (body) combined with ramus procedure or not - open bite / spees curve reduction Genioplasty Indications: - chin deformities Pre treatment Model Surgery Post Le Fort I & genioplasty SNA88 SNB81 ANB 7 SNA84 SNB81 ANB 3 Distraction Osteogenesis 颅骨外固定牵引装置颅骨外固定牵引装置 截骨位置截骨位置 口内固定牵引装置口内固定牵引装置 3-D CT3-D Model Simulated Operation Surgery Distraction Osteogenesis 颞颌关节成形颞颌关节成形/ /再造术再造术 颏前移舌骨悬吊术颏前移舌骨悬吊术 上、下颌牵引成骨术上、下颌牵引成骨术 双颌前移术双颌前移术 颌骨重建术颌骨重建术 颅颌硬组织颅颌硬组织 畸畸 形或缺损患形或缺损患 者者 手术治手术治 疗疗 术前正压术前正压 通气治疗通气治疗 以以形态形态畸形原因畸形原因 为主患者为主患者 呼吸道管理呼吸道管理 随随 访访 术术 后后 留管留管1 13 3天天 CPAPCPAP 减肥减肥/ /体重控制体重控制 患者患者 患者颅颌面检查患者颅颌面检查 头颅定位测量分析头颅定位测量分析 鼻咽纤维镜鼻咽纤维镜 上气道压力检测上气道压力检测 神经神经- -肌功能检查肌功能检查 PSGPSG 上气道上气道 形态学形态学 和功能和功能 检查检查 阻阻 塞塞 原原 因因 部部 位位 程程 度度 CPAPCPAP 非手术治疗非手术治疗 口腔功能矫治器口腔功能矫治器 减肥减肥 睡眠呼吸障碍诊疗睡眠呼吸障碍诊疗 颅颌软组织畸形颅颌软组织畸形 患者（肥胖、肿患者（肥胖、肿 瘤等患者）瘤等患者） 体重控制、减肥治疗体重控制、减肥治疗 定量定量UPPPUPPP术舌骨悬吊术术舌骨悬吊术 射频温控减容术射频温控减容术 双颌前移术双颌前移术 肿瘤重建手术肿瘤重建手术 舌根舌根/ /舌体减容术舌体减容术 Thank You 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