专业英语 Unit 28教案学习资料

UnitTwentyEightModernPracticeinOrthognathicalarReconstructiveSurgeryOrthognathicsurgerywasinitsinfancywhenSurgicalCorrectionofDentofacialDeformitieswaspublishedin1980(Volumesland2)and1985(Volume3).Sincethen,ithasevolvedintoacomplexspecialtythatdemandsexpertiseinseveralsurgicaldisciplinesandanunderstandingofmanyallieddentalandmedicalspecialties.Becauseorthognathicsurgeryhasbeenandremainsevolutionary,themodemsurgeon'strainingisacontinuum.Duringthepast15years,quantumleapshaveoccurredinscientificknowledge,intechnology,andinsometreatmentplanningaspectsofthisdynamicfield.Theconceptofbeautyiscentraltohumanculturesandisdeeplyrootedinthenatureofman.Invariousways,humanestheticsiswovenintothetraditionofhumancivilizations.Physicalappearancehasalwaysplayedasignificantroleinthedevelopmentofself-conceptandself-esteem,intheestablishmentofinterpersonalrelationships,inemploymentopportunities,andeveninthequalityoflife.Areviewofourpreviouslytreatedpatientsandpastpublicationsclearlyrevealsthatmanyofoutorthognathicsurgicalproceduresachieveestheticfacialproportions,improvejawfunction,andaccomplishocclusalstability.Inselectedcases,however,theresultwascompromisedbecausetheindependentsofttissuecomponentswerenotsystematicallyanalyzedandtreated.Ofallthehumanfamily,themodernsurgeonshouldbethemostvigilantandaccuraterecorder01facialesthetics.Today'soralandmaxillofacialsurgeonmustbetrainedincosmeticfacialsurgeryandmustbecompetenttodiagnoseandtreatbothskeletalandsofttissueproblems.Byvirtueofthepresentleveloftraining,heorshehasuniquediagnosticandtechnicalskillstoaddressandcorrectbothhardandsofttissueaberrations.Duringthepastdecade,greatstrideshavebeenmadetoincorporatethesetwodisciplines:Aninterdisciplinaryhasthusevolved.SectionsⅠandⅡofModemPracticeinOrthognathicandReconstructiveSurgeryfocusontreatmentplanningandset'forthobjectivecriteriafortheappreciationoffacialestheticsandbeauty.Avarietyofelementsthatrelatetothestructuralbeautyofthedental,facial,andcraniofacialcompositionaredescribed.Therapeuticmeansofalteringthehumanmorphopsychologicalfeaturesofdentocraniofacialdeformitiesbyrestorative,gingival,orthognathicandcraniofacialproceduresaredescribedindetail.Alargeproportionofadultsandadolescentswithdentocraniofacialdeformitiesmanifestaspectrumoffunctionalproblems(SectionsⅢandⅣ).Abalancedbiomechanicalrelationshipbetweenthemasticatorymuscles,jaws,temporomandibularjoints,andteethisnecessarytoachievenormalfunctionaftersurgicalrepositioningofthejaws.Properplanning,precisesurgicaltechnique,efficientorthodonticsusedinconcertwithsmallboneplateandscrewosteosyntheses,andsystematicmuscularrehabilitation-allincreasetreatmentefficiencyandfrequentlyimprovejawfunction.Inthetreatmentoftemporomandibularjointpainanddysfunctionthroughbalancingthebiomechanicalrelationshipsbetweenthemasticatorymuscles,jaws,temporomandibularjoints,andteeth,thecommondenominatorofsuccessisthatthepatienthasanappropriaterangeofmotionandisfreeofpain.Canimprovedfunctionbeexplainedonthebasisofimprovedocclusion?Istheconceptofapathologicocclusionlegitimate?Tovalidatetheseconcepts,theconceptofocclusionmustbebroadenednotonlytothecontactrelationshipsoftheteethandthey’recontrollingneuromuscularsystembutadditionallyandmoreimportantlytothefunctionanddysfunctionofthemasticatorysystem.Inthiscontext,malocclusionmaybeconsideredpathologic.Anewmindsethasbeendevelopedthatconsiderstherelationshipsbetweentheteeth,temporomandibularjoints,muscles,andjaws.Inthiscontext,orthognathicsurgicalproceduresnotonlymayimprovetheinterdigitationoftheteethbutalsomayhaveapositiveimpactonfunctionbycreatingabalancedenvironmentfortheteeth,temporomandibularjoints,muscles,andjaws.Itisimpossibletomasterorthognathicsurgicaltechniqueswithoutalsobeingastudentofthetemporomandibularjoint.Theinterrelationshipbetweentheteeth,joints,muscles,andjawsaspartofafunctionalunitmustbeunderstood.Onlywhenweknowhowthismasticatorysystemwasdesignedtoworkcanweknowwhatiswrongwithitwhenitisnotfunctioningcorrectly.Theresultstodatein-patientswithTMJdisordersandchronicpaintreatedwithselectiveorthognathicsurgicalproceduresandadditionalexperiencewithotherpatients,withorwithout.Malocclusionsprovidesupportfortheselectiveuseofmaxillaryandmandibularosteotomiesintreatingtemporomandibularjointpainanddysfunction.Inaddition,surgicalrepositioningofthejawsmayhaveapositiveimpactonpatientswhomanifestobstructivesleepapneaandspeechdisorders.Whenthelimitedavailableproceduresinpreprostheticsurgeryfailedtoresolvethedilemmaofthecompleteorpartiallyedentulouspatient,researchonosseointegratedimplants,bonegraftingtechniques,reconstructivetissuetechniques,anddevelopmentofcompatibleceramicmaterialsopenednewvistasfortreatmentofthepreprostheticandreconstructivesurgerypatient.Treatmentofthecompletelyorpartiallyedentulouspatientwasrevolutionizedwiththeintroductionoftheconceptofimplantosseointegration.ThisconceptcametoBranemarkserendipitouslyduringmicrovascularbonemarrowstudiesonliverabbits.Heobservedthatscrew-configuredtitaniumvitalmicroscopicchamberswereinseparablyincorporatedwithinlivingtissueandwereimpossibletoremove.Thereafter,aseriesofinvestigationsultimatelyledtotheclinicalapplicationofosseointegration.ThefunctionalrestorationofthedentalocclusionandassociatedstructureswithimplantsisdescribedinSectionV.Impressivesuccesseswithbothmaxillaryandmandibularimplantshavebeenduplicatedinmulticenterreplicationstudieswithvariousimplantsystems.Osseointegratedimplantshavesincebecomealeadingedgeintheintegrationofsurgeryintomedicalanddentalspecialties;indeed,ithastouchedallhealingdisciplines.Variousinvestigatorshaverepeatedthesuccessfulutilizationofosseointegrationforboneanchorageintheprostheticmanagementofcraniofacialdefects.Today,aseeminglyendlessvarietyofprosthetic,craniofacial，andorthopediccombinationscanbeemployedtoreplacemissingpartsofthebody.Anatomicmodelsurgeryinconcertwiththeuseofextraoralverticalreferentshasmadethree-dimensionalrepositioningofthejawsfeasible,moreprecise,andmorepredictablethanhadbeenpossiblewithtraditionalmethods.Individualizationofosteotomydesignsbaseduponanatomic,biomechanical,biologic,functional,andestheticcriteriahascontributedsignificantlytothedevelopmentofnewsurgicalprocedureswithmorepredictable,stable,functional,andestheticresults.Rigidinternalfixationhasbeenwellacceptedbypatientsandmostprofessionalsactivelyinvolvedinorthognathicsurgery.Theuseofboneplateandscrewosteosynthesishasvirtuallyeliminatedtheneedformaxillomandibularfixationanddramaticallyalteredpostsurgicalneuromuscularandocclusalrehabilitation.Additionally，theconceptsofselectivelyalteringtheocclusalplane,managingshortmandibularramusdeformities,androtatingthemandiblecounterclockwisehavecomeofagethroughthemodificationofrigidinternalandskeletalfixationtechniques.Properlyplannedandpreciselypositionedosteotomiesinconcertwithorthopedicappliancesfacilitateanincreaseofthearchlengthinboththemaxillaandthemandibleandpermitsurgicalorthodontictreatmentofthemajorityofdentofacialdeformitypatients,withoutextractionofteeth.Suchtherapygreatlyimprovestreatmentefficiencyandeffectiveness.CharlesLindbergh:"Whatkindofmenwouldlivewherethereisnodaring?Idon'tbelieveintakingfoolishchances,butnothingcanbeaccomplishedwithouttakinganychanceatall.”Aspecialtyderivesitsstandardsfromselectedindividualswhoemergetotaketheirplaceinhistory.Ihaveattemptedtoselectsomeoftheseindividualswhohavemadeandwillcontinuetomakeasignificantimpactonthespecialtyoforalandmaxillofacialsurgery.Eachcontributorisactiveanddynamicinaparticularfieldofinterest.Volumel,2,and3ofModernPracticeinOrthognathicandReconstructiveSurgerydescribetheworkofvisionaries,creativethinkers,andpioneerswhodaredtotake"thefirststep."Throughtheirefforts,ourspecialtycontinuestomoveforwardtonewheights.Asafamilyoforalandmaxillofacialsurgeons,wepossessthepowerfulforceofourspecialtyspirit.Wemustspreadtopeoplethroughouttheworldthegoodthingswehavelearnedthroughourparents,ourteachers,andourcolleagues.Theworldstandstobenefitfromallthevalueswehavebeensofortunateandprivilegedtolearnasprofessionallytrainedpeopledo.Haughty,selfishspecialtyprideand"turfbuilding"limitprogressand'thegoodthatcanbedone.Thesurgicalproceduresandmethodsoftreatment(whichmustbecorrectlytaught)describedinthesebooksshouldbeavailabletoallpatientsandspecialiststhroughouttheworld.Maythesebookscontributetothisend?Scienceisauniversallanguagesuccessfullyspokenataltinternationalmeetings.Weliveinanageofimmediatecommunications.Thattheknowledgefoundinthesebookswilltouchpeopletheworldoverisanexcitingthoughtthatpromptedmetopursuethewritingandeditingofthesethreevolumescontaininginformationfromcontributorsallovertheworld.Inthecourseofreadingthesebooks,itishopedthatyouwillwanttodomuchexperimentingwiththebonesandsofttissuesthatmakeupthehumanface.Afterall,itisyourparticipationthatwi