牙颌面畸形小讲课蔡鸣

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  • Deformità dento-facciali: http://www.giuseppespinelli.it/chirurgia-estetica-maxillo-facciale/chirurgia-ortognatica.html
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牙颌面畸形小讲课蔡鸣

  1. 1. Dental-facial Deformities Cai Ming Dept. of OMS, Shanghai 9 th people’s hospital, Jiao tong University
  2. 4. Orthognathic Surgery <ul><li>Definition </li></ul><ul><li>Classification </li></ul><ul><li>Treatment plan </li></ul>
  3. 5. CLASSIFICATION <ul><li>Vertical </li></ul><ul><li>Sagittal </li></ul><ul><li>Transverse </li></ul><ul><li>Bimaxillary </li></ul><ul><li>Asymmetric </li></ul><ul><li>Hyperplasia </li></ul><ul><li>Hypoplasia </li></ul>
  4. 6. Angle 分类 Angle Ⅰ 正常 Angle Ⅰ 错 Angle Ⅱ 错 Angle Ⅲ 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
  5. 7. ETIOLOGY <ul><li>Congenetial </li></ul><ul><li>Acquired </li></ul>
  6. 8. EXAMINATION <ul><li>History </li></ul><ul><li>Clinical finding </li></ul><ul><li>Laboratory </li></ul>
  7. 9. Laterally Frontally
  8. 10. <ul><li>Teeth </li></ul><ul><li>Dental </li></ul><ul><li>Mouth opening </li></ul><ul><li>TMJ </li></ul><ul><li>X-Ray </li></ul><ul><li>Model </li></ul><ul><li>Photographic </li></ul>
  9. 11. Cephelometric Analysis
  10. 12. <ul><li>硬组织测量标志点 </li></ul>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)  
  11. 13. 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 ) <ul><li>软组织测量标志点 </li></ul>
  12. 14. Reference Plane and Angel
  13. 15. Case SNA 78 ° SNB 85 ° ANB 7 ° SNA 76 ° SNB 70 ° ANB 6 ° S N A B S N A B
  14. 16. Treatment Plan Joint orthognathic & orthodontic assessment Orthognathic Surgery Examination Diagnosis Presurgical Orthodontics Postsurgical Orthodontics Surgical Plan
  15. 17. Objective of Presurgical Orthodontic <ul><li>Decompansation </li></ul><ul><li>(angulation teeth, accentuate deformities) </li></ul><ul><li>Alignment </li></ul><ul><li>Compatibility </li></ul>
  16. 18. PREPARATION <ul><li>Caries & Peridontal disease </li></ul><ul><li>Visal treament objective </li></ul><ul><li>Model surgery </li></ul><ul><li>Computer aided analyze </li></ul>
  17. 19. VTO
  18. 23. SURGICAL TREAMENT PHASE <ul><li>Maxilla </li></ul><ul><li>Mandible </li></ul>
  19. 24. Maxillary segmental osteotomy (Anterior / Posterior) Indications: - maxillary protrusion - marked protrusion of maxillary teeth - open bite
  20. 25. Le Fort I osteotomy (total or segmental) Indications: - maxillary deformities - mandibular deformities
  21. 26. 常用正颌外科截骨线 --- Le fort I osteotomy
  22. 27. Le Fort II or III osteotomy Indications: - midface deficiency
  23. 30. Sagittal split ramus osteotomy, SSRO Indications: - mandibular excess - mandibular deficiency - mandibular asymmetry Ad back rotate
  24. 32. Vertical ramus osteotomy Indications: - mandibular excess - mandibular asymmetry (combined with SSRO) back
  25. 33. Subapical osteotomy Indications: - bimaxillary protrusion / open bite - leveling the plane of occlusion - uprighting anterior teeth
  26. 34. Body osteotomy Indications: - mandibular excess (body) combined with ramus procedure or not - open bite / spee’s curve reduction
  27. 36. Genioplasty Indications: - chin deformities
  28. 37. Pre treatment
  29. 38. Model Surgery
  30. 39. Post Le Fort I & genioplasty
  31. 40. SNA 88 ° SNB 81 ° ANB 7 ° SNA 84 ° SNB 81 ° ANB 3 °
  32. 41. Distraction Osteogenesis
  33. 42. 颅骨外固定牵引装置 截骨位置 口内固定牵引装置
  34. 43. 3-D CT 3-D Model
  35. 44. Simulated Operation
  36. 45. Surgery
  37. 46. Distraction Osteogenesis
  38. 48. 患者 睡眠呼吸障碍诊疗 <ul><li>颞颌关节成形 / 再造术 </li></ul><ul><li>颏前移舌骨悬吊术 </li></ul><ul><li>上、下颌牵引成骨术 </li></ul><ul><li>双颌前移术 </li></ul><ul><li>颌骨重建术 </li></ul>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… <ul><li>呼吸道管理 </li></ul><ul><li>随访 </li></ul>术后 留管 1 - 3 天 CPAP <ul><li>减肥 / 体重控制 </li></ul><ul><li>患者颅颌面检查 </li></ul><ul><li>头颅定位测量分析 </li></ul><ul><li>鼻咽纤维镜 </li></ul><ul><li>上气道压力检测 </li></ul><ul><li>神经 - 肌功能检查 </li></ul>PSG 上气道 形态学和功能 检查 阻塞 原因 部位 程度 CPAP 非手术治疗 口腔功能矫治器 减肥 颅颌软组织畸形 患者(肥胖、肿 瘤等患者) <ul><li>体重控制、减肥治疗 </li></ul><ul><li>定量 UPPP 术+舌骨悬吊术 </li></ul><ul><li>射频温控减容术 </li></ul><ul><li>双颌前移术 </li></ul><ul><li>肿瘤+重建手术 </li></ul><ul><li>舌根 / 舌体减容术 </li></ul>
  39. 49. Thank You

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