目的:探討在正頜外科手術(shù)中同期完成下頜骨的塑型手術(shù)、上頜骨前壁骨移植或Medpor植入術(shù)的可行性。方法:18例女性患者,平均年齡23歲。均診斷為牙頜面畸形,其中下頜前突或伴下頜骨偏斜畸形13例,雙頜前突畸形2例,上頜后縮伴下頜前突畸形3例。對上述病例進行正頜外科手術(shù)的同時行下頜骨的塑型和(或)上頜骨的骨移植或Medpor植入術(shù)、頦成型術(shù)。結(jié)果:所有病例在術(shù)后均出現(xiàn)下唇的麻木,但術(shù)后1~6個月下唇感覺恢復(fù)正常。無牙齒損傷、傷口感染和骨段壞死發(fā)生。經(jīng)過6~23個月的正畸治療,均獲得良好的咬合關(guān)系和協(xié)調(diào)的面部比例關(guān)系及滿意的面部輪廓。術(shù)后6個月~3年影像檢查評估結(jié)果表明骨移植成活良好,較少出現(xiàn)骨吸收的現(xiàn)象。結(jié)論:在正頜手術(shù)的同時進行下頜骨的塑型和(或)上頜骨骨移植或Medpor植入術(shù)是可行的,可增加術(shù)后面部的美學(xué)效果和患者的滿意度,同時不增加手術(shù)并發(fā)癥。下頜骨截除的骨質(zhì)可以用于正頜手術(shù)中,避免了其他部位的取骨。

Objective: To explore the feasibility of mandibuloplastic surgery or augmentation on the maxilla with autologous bone or Medpor during the orthognathic surgery. Methods: In this series,18 consecutive patients(females, average age 23) with dentofacial deformities,were underwent orthognathic surgeries and mandibuloplasti-es, or augmentation on the maxilla with autologous bone or Medpor. Dentofacial deformities were classified as mandi-ble prognathism (or complicated by mandible deviation) with class Ⅲ malocclusions in 13, bimaxillary protusion in 2, maxilla retrusion and mandible prognathism in 3. Results: All patients showed normal sensibility of the lower lip after a 6-month postoperative follow-up, that indicated that inferior alveolar nerve functional was not be affected perpetually. Teeth injury,infection or bone segment necrosis didn't occur in this series. Normal occlusions were established after the postoperative 6 to 23-month orthodontic treatment in the all patients. Harmonious and attractive facial contours are achieved in the all patients. The grafted bone present less bone resorption in some patients by radiographic assessment after from 6-month to 3-year surgery. Conclusion: The study shows that mandibuloplasty or/and augmentation on the maxilla can be safely performed at the time of orthog-nathic surgery,and improve the results and the patient's satisfaction.Moreover, this additional surgeries don't increase the complication rate.Osseous tissue from mandibuloplastic surgery can be used as bone grafting for orthognathic surgery and it avoids the harvesting bone from other parts.

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