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目的:探讨牵引成骨技术联合正颌正畸治疗重度小下颌伴偏颌畸形患者下颌骨严重发育不足及咬合关系紊乱的疗效。方法:对2例继发于儿童时期颞下颌关节损伤的小下颌伴偏颌畸形患者采用牵张成骨技术进行治疗。手术行双侧下颌角处截骨,安置牵引器,延长下颌升支及下颌体。第二期在拆除牵引器后进行正畸治疗,继而采用正颌外科方法进一步矫正颌面畸形及咬合关系,术后正畸治疗矫正咬合关系,排齐牙列。结果:2例患者均顺利完成治疗。下颌骨最小牵引距离25 mm,最大牵引距离30 mm,牵引区成骨良好,SNB角由术前平均67°增加到术后80°,小下颌及偏颌畸形得以矫治。联合正颌外科及正畸治疗后,面形及咬合功能均获得满意效果。术后经过2年6个月随访,未见复发。结论:联合应用牵张成骨和正颌外科技术并配合正畸治疗是矫治成人重度小下颌不对称性牙颌面畸形的有效治疗方案。
Objective: To investigate the effect of distraction osteogenesis combined with orthognathic orthodontics on severe mandibular dysplasia and occlusion in patients with severe mandible and maxillary malformation. Methods: Two cases of small mandibular and maxillary malformation secondary to the temporomandibular joint injury secondary to childhood were treated by distraction osteogenesis. Surgical operation of bilateral mandibular angle osteotomy, placement of tractors, extended mandibular ascending and mandibular body. The second phase of orthodontic treatment after removal of the tractor, followed by orthognathic surgical methods to further correct the maxillofacial deformity and occlusion, postoperative orthodontic treatment to correct the occlusion relationship, alignment dentition. Results: Two patients completed the treatment successfully. The minimum mandibular traction distance was 25 mm and the maximum traction distance was 30 mm. The osteotomy in the traction zone was good. The SNB angle was increased from 67 ° preoperatively to 80 ° postoperatively. The mandibular and maxillary deformities were corrected. Joint orthognathic surgery and orthodontic treatment, the shape and occlusal function were satisfactory results. After 2 years and 6 months follow-up, no recurrence was found. Conclusion: The combined application of distraction osteogenesis and orthognathic surgery combined with orthodontic treatment is an effective treatment for the treatment of severe mandibular asymmetric maxillofacial deformities in adults.