正畸课件1讲义整理

Dental-facialDeformitiesCaiMing

Dept.ofOMS,Shanghai9thpeople’shospital,JiaotongUniversityDental-facialDeformitiesCaiM1正畸课件1讲义整理2正畸课件1讲义整理3OrthognathicSurgeryDefinitionClassificationTreatmentplanOrthognathicSurgeryDefinitio4CLASSIFICATIONVerticalSagittalTransverseBimaxillaryAsymmetricHyperplasiaHypoplasiaCLASSIFICATIONVerticalHyperp5Angle分类AngleⅠ正常AngleⅠ错AngleⅡ错AngleⅢ错牙合牙合牙合牙合下颌后缩或上颌前突上颌后缩或下颌前突Angle分类AngleⅠ正常AngleⅠ错Angle6ETIOLOGYCongenetialAcquiredETIOLOGYCongenetial7EXAMINATIONHistoryClinicalfindingLaboratoryEXAMINATIONHistory8LaterallyFrontallyLaterallyFrontally9TeethDentalMouthopeningTMJX-RayModelPhotographicTeethX-Ray10CephelometricAnalysisCephelometricAnalysis11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)

硬组织测量标志点颅部 蝶鞍点（S）上颌骨 前鼻棘(ANS12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）软组织测量标志点额点（G）软组织测量标志点13ReferencePlaneandAngelReferencePlaneandAngel14CaseSNA 78°SNB 85°ANB 7°SNABSNABSNA 76°SNB 70°ANB 6°CaseSNA 78°SNABSNABSNA 76°15TreatmentPlanExaminationDiagnosisJointorthognathic&orthodonticassessmentPresurgicalOrthodonticsPostsurgicalOrthodonticsSurgicalPlanOrthognathicSurgeryTreatmentPlanExaminationDiagn16ObjectiveofPresurgicalOrthodonticDecompansation

(angulationteeth,accentuatedeformities)AlignmentCompatibilityObjectiveofPresurgicalOrtho17PREPARATIONCaries&PeridontaldiseaseVisaltreamentobjectiveModelsurgeryComputeraidedanalyzePREPARATIONCaries&Peridont18VTOVTO19正畸课件1讲义整理20正畸课件1讲义整理21正畸课件1讲义整理22SURGICALTREAMENTPHASEMaxillaMandibleSURGICALTREAMENTPHASEMaxill23Maxillarysegmentalosteotomy(Anterior/Posterior)Indications:-maxillaryprotrusion-markedprotrusionof

maxillaryteeth-openbiteMaxillarysegmentalosteotomy24LeFortIosteotomy

(totalorsegmental)Indications:-maxillarydeformities-mandibulardeformitiesLeFortIosteotomy

(totalo25常用正颌外科截骨线---LefortIosteotomy常用正颌外科截骨线---LefortIosteoto26LeFortIIorIIIosteotomyIndications:-midfacedeficiencyLeFortIIorIIIosteotomyIn27正畸课件1讲义整理28正畸课件1讲义整理29Sagittalsplitramusosteotomy,

SSROIndications:-mandibularexcess-mandibulardeficiency-mandibularasymmetryAdbackrotateSagittalsplitramusosteotomy30正畸课件1讲义整理31VerticalramusosteotomyIndications:-mandibularexcess-mandibularasymmetry

(combinedwithSSRO)backVerticalramusosteotomyIndica32SubapicalosteotomyIndications:-bimaxillaryprotrusion/openbite-levelingtheplaneofocclusion-uprightinganteriorteethSubapicalosteotomyIndication33BodyosteotomyIndications:-mandibularexcess(body)

combinedwithramusprocedureornot-openbite/spee’scurvereductionBodyosteotomyIndications:34正畸课件1讲义整理35GenioplastyIndications:-chindeformitiesGenioplastyIndications:36PretreatmentPre37ModelSurgeryModelSurgery38PostLeFortI&genioplastyPost39SNA 88°SNB 81°ANB 7°SNA 84°SNB 81°ANB 3°SNA 88°SNA 84°40DistractionOsteogenesisDistractionOsteogenesis41颅骨外固定牵引装置截骨位置口内固定牵引装置颅骨外固定牵引装置截骨位置口内固定牵引装置423-DCT3-D

Model3-DCT3-DModel43Simulated

OperationSimulatedOperation44SurgerySurgery45Distraction

OsteogenesisDistractionOsteogenesis46正畸课件1讲义整理47颞颌关节成形/再造术颏前移舌骨悬吊术上、下颌牵引成骨术双颌前移术颌骨重建术颅颌硬组织畸形或缺损患者

手术治疗术前正压通气治疗以形态畸形原因为主患者…呼吸道管理随访术后留管1－3天CPAP减肥/体重控制患者患者颅颌面检查头颅定位测量分析鼻咽纤维镜上气道压力检测神经-肌功能检查PSG上气道形