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الجراحة التقويمية لحالات الصنف الثالث - فرح العلبي=
الجراحة التقويمية لحالات الصنف الثالث - فرح العلبي=
-سوء اطباق صنف اثلث هيلكي مع تراجع فك علوي او تقدم فك سفيل او مشاركة بيهنام.
وان معاجلة الصنف الثالث الهيلكي يف فرتة البلوغ وعند املرىض اذلين توقف دلهيم
المنو يه:
-املعاجلة لمتويه التباين الهيلكي للصنف الثالث سواء متويه سين او حىت جرايح.
-املشاركة بني املعاجلة التقوميية واجلراحة التقوميية الفكية وهو ما سنتناوهل يف حمارضة اليوم.
نمو زائد للفك السفلي عن الطبيعي قد يظهر منذ مرحلة الطفولة وغالبا •
يظهر بمرحلة المراهقة واحيانا حتى بداية قفزة النمو البلوغية.
مطاط ص$نف ثال$ث خفي$ف +مطاط مثلث$ي عن$د االنياب م$ع اقواس مضلع$ة بالف$ك العلوي
توضع مباشرة بعد الجراحة.
Essentials of Orthognathic Surgery -Second Edition - Reyneke 2010
تزال الج$بيرة واقواس االس$تقرار مع$ا عندم$ا يتأك$د الجراح ان الشفاء اص$بح كاف ويس$تعمل مطاط
(يفضل مطاط heavy 200غ مثلثي مع مطاط صنف ثالث) كامل الوقت.
هذا وان حركات االس$نان بع$د الجراح$ة مفضل$ة بالف$ك الس$فلي ع$ن العلوي لذل$ك يوضع قوس مضل$ع
بالعلوي وس$لك ss 0,016س$فل$ي لمدة شه$ر او شهرين .وعن$د الخوف م$ن ا$لنك$س يمك$ن اس$تعمال
مطاط ص$نف ثال$$ث خفي$ف ليال م$$ع جهاز متحرك علوي وضامات تث$بيت او اطواق باإلضاف$ة$
لخطافات على االنياب العلوية والسفلية لتثبيت المطاط.
اهم المالحظات:
-1ف(ي حال وجود ازدحام شدي(د او حاج(ة لإلرجاع االمام(ي نقل(ع الضواح(ك االول(ى
العلوية .
-2ف(ي حال وجود ازدحام خفي(ف وعدم الحاج(ة لإلرجاع االمام(ي نقل(ع ضواح(ك ثاني(ة
علوية .
-3ف(ي حال وجود ازدحام بالقطاع االمام(ي الس(فلي او رغب(ة بالت(بريز او التعمي(د نقل(ع
ضواحك ثانية سفلية.
االفضل قلع ضواحك اولى علوية مع ضواحك ثانية سفلية.
الفك السفلي- :رصف وتسوية القوس السفلية مع التوضيع الصح(يح للقواطع السفلية.
-عندم$ا يجرى توضي$ع س$فلي للف$ك العلوي( وه$و اجراء ناك$س) الب$د م$ن التغل$ب عل$ى العاملي$ن
المساهمين بالنكس وهما:
مثل HAوهي االفضل. فال بد من استعمال طعوم .Iتثبيت غير صلب بالفك العلوي
اجرا$ء جراحة على الرأد. .IIاطباق الفك ال$سفلي
The material consisted of 31 patient (15 female, 16 male cases, mean age was 26.7 ± 2.5 years) with Class
III skeletal deformity. All patients were treated by Le Fort I maxillary advancement and mandibular setback
surgery with sagittal split osteotomy. Lateral cephalograms were taken before and 1.4 ± 0.3 years after
surgery. Wilcoxon test was used to compare the pre- and post-surgical measurements. Pearson correlation
.test was used to compare the relationships between the skeletal, dental and facial soft tissue changes
In the maxilla, the APOINTAP (the anteroposterior position of A point) and ITIPAP (the anteroposterior
position of upper incisor) showed significant protractions (−3.19 ± 3.63, and −3.19 ± 4.52, p < 0.01). In the
mandible, the L1TIPAP (the anteroposterior position of lower incisor, −3.20 ± 5.83, p < 0.01), L1TIPSI (the
superoinferior position of lower incisor, −2.43 ± 10.31, p < 0.05), BPOINTSP (the superoinferior position of B
point, −2.28 ± 12.51, p < 0.05) and BPOINTAP (the anteroposterior position of B point, −3.19 ± 9.31, p <
0.01) showed significant retractions and upper positions after bimaxillary surgery. The insignificant
decrease in soft tissue Pog–Vert distance was correlated the significant upper position of B point and lower
.incisor (r: 0.851, p < 0.001 and r: 0.842, p < 0.001)
Components of adult class III
malocclusion
Available online 23 May 2008
Abstract
To identify the skeletal and dental relationships of adults who have class III
malocclusion, lateral cephalograms of 302 adult patients who had a class III
molar and cuspid relationship were traced. Ninety-four of the patients had
had presurgical orthodontic treatment and 208 had not. The tracings were
digitized, and the following sets of measures were analyzed: maxillary
skeletal position; maxillary dentoalveolar position; mandibular dentoalveolar
position; and mandibular skeletal position. In addition, the mandibular plane
angle and lower anterior facial height were measured as an indicator of
vertical facial dimensions. None of these values demonstrated significant
gender differences except lower anterior facial height; therefore, the
subjects were treated as a group. Although there was considerable variation
among patients, the most common combination of variables was a retrusive
maxilla, protrusive maxillary incisors, retrusive mandibular incisors, a
.protrusive mandible, and a long lower facial height
Skeletal relapse after mandibular
advancement and setback in single-jaw
surgery
Available online 25 November 2004
Purpose
The aim of this study was to identify contributing factors to skeletal relapse by analyzing cephalometric changes
.after bilateral sagittal split ramus osteotomy
Patients and methods
This study included 60 consecutive patients who underwent either mandibular advancement (30 patients) or
setback surgery (30 patients). There were 36 women and 24 men (mean age, 23 years). The radiographs of these
patients taken immediately before operation, at 1 week, and 14 months postoperatively were studied. To analyze
the influence of hyper- and hypodivergent facial patterns on the surgical outcome, the patients were divided into
.3 groups according to the mandibulo-nasal plane angle. The position of the maxilla was also taken into account
Results
Measured at B-point, skeletal relapse was 1.3 mm (30%) after mean advancement of 4.4 mm and 0.8 mm (12%)
after setback of 6.0 mm. The magnitude of the surgical movement correlated with skeletal relapse. However, the
correlation was not linear. Advancement of greater than 7 mm is associated with an increased tendency to relapse
(r = 0.52), but setback of more than 12 mm with a decreased tendency (r = −0.95). The retrognathic patients with
a high mandibulo-nasal plane angle (hyperdivergence) had 30% higher relapse rate. Patients with hypodivergent
.facial patterns had less relapse in both advancement and setback surgery
Conclusion
Skeletal relapse was affected by magnitude of surgical movement and different facial patterns according to the
mandibulo-nasal plane angle; however, influences of both factors were different between mandibular
.advancement and setback
Skeletal and dental relapses after skeletal class III
deformity correction surgery: single-jaw versus
double-jaw procedures
Available online 22 November 2012
Objective
In this prospective comparative study, we looked at the postoperative dental and skeletal
relapses in patients undergoing orthognathic surgery for skeletal class III deformity. The surgical
.interventions were single-jaw versus double-jaw procedures
Study Design
Twenty-four adult patients with skeletal class III deformity presented with functional and esthetic
problems. Patients were randomized to receive single- or double-jaw corrective surgery. The
assessment of outcome was by lateral cephalograms taken at different intervals and postoperative
.complications
Results
At 1 year after surgery, no significant correlation was identified between surgical advancement
and relapse regarding maxillary stability. The single-jaw procedure cohort had a significantly
greater horizontal mandibular skeletal relapse. No differences were noted when examining the
.mandibular vertical stability. None of the patients reported any acute local neurology
Conclusions
Single-jaw procedure may lead to less stability, leading to skeletal relapse, than double-jaw
.procedure. A higher evidence-based study and larger cohort is required to prove this
Three-dimensional evaluation of soft tissue changes after mandibular
setback surgery in class III malocclusion patients according to extent of
.mandibular setback, vertical skeletal pattern, and genioplasty
May 2010
Source
.Department of Dentistry, College of Medicine, Korea University, Seoul, Korea
Abstract
:OBJECTIVE
.To investigate the 3-dimensional (3D) changes in the soft tissue after mandibular setback surgery (MSS)
:STUDY DESIGN
Thirty-three skeletal class III malocclusion (SCIII) patients treated with MSS (bilateral sagittal split
ramus osteotomy) were subdivided according to extent of MSS, vertical skeletal pattern (VP), and
vertical-reduction genioplasty. Lateral cephalograms and 3D facial scan images were taken before and 6
months after surgery. Linear and angular variables were measured with Rapidform 2006 (Inus
.Technology)
:RESULTS
After MSS, there were significant increases in the upper lip length and decreases in the lower lip length
in the large setback, hypodivergent, and genioplasty groups. The mentolabial fold deepened less in the
genioplasty group than in other groups. Although there was no skeletal advancement of the maxilla, the
soft tissue convexity in the paranasal area increased more in the hyperdivergent group than in the
.hypodivergent group after MSS
:CONCLUSION
The extent of MSS, VP, and genioplasty could be used as guidelines for 1- and 2-jaw surgeries in SCIII
.borderline cases
THE END