Ortognatik Cerrahi Tedavi ve Yumuşak Dokular Üzerindeki Etkisi

Yıl 2021, Cilt: 30 Sayı: 1, 1 - 12, 31.03.2021

Gökhan Çoban İbrahim Yavuz

https://doi.org/10.17827/aktd.646734

Öz

Büyüme gelişimini tamamlamış hastalarda tek başına ortodontik düzeltimin kapasitesini aşan şiddetli iskeletsel uyumsuzlukların tedavisinde kullanılan ortodontik ve cerrahi prosedürler ortognatik cerrahi olarak adlandırılmaktadır. Bu tedavinin sonucunda kabul edilebilir ve dengeli bir yüz görünümüne, çiğneme ve konuşma fonksiyonlarına kavuşulması ve hastanın esas şikâyetlerinin çözülmesi amaçlanmalıdır. Yüzün yumuşak doku hatları, altta yatan yüz iskeletini yansıtmaktadır, bu nedenle iskeletsel uyumsuzluklar kaçınılmaz olarak yüzün yumuşak dokularını etkilemektedir. Ortodontinin uzmanlık alanı olarak ilk kurulduğu 1900’lu yıllarda, tedaviler ‘Angle’ın sert doku paradigması’na göre, öncelikli olarak okluzyonun ideale getirilmesi şeklinde planlanmaktaydı; ancak son yıllarda, ortodonti ve ortognatik cerrahi tedavide, dentofasiyal problemlerin yüzün yumuşak dokularındaki tedavisine odaklanan ‘yumuşak doku paradigması’ kabul görmeye başlamıştır. Bu yaklaşımda tedavinin sonunda, öncelikli olarak olarak yüz yumuşak dokularının adaptasyonu ve dengesi amaçlanmaktadır. Bu makalede, ortognatik cerrahi tedavinin endikasyonları, hareket kapasitesi ve yumuşak dokular üzerindeki etkilerini ele alan bir literatür derlemesi sunulmuştur. 

Anahtar Kelimeler

ortognatik cerrahi tedavi, yumuşak doku analizi, ortodontik tedavi

Orthognathic Surgical Treatment and Its Effect on Soft Tissues

Öz

Orthodontic and surgical procedures used in the treatment of severe skeletal discrepancies exceeding the capacity of orthodontic treatment alone in patients who have completed their growth and development are called orthognatic surgery. As a result of this treatment, it should be aimed to achieve an acceptable and balanced face appearance, masticatory and speaking functions and to solve the chief complaints of the patient. The soft tissues of the face reflect the underlying skeletal structure, so skeletal discrepancies inevitably affect the soft tissues of the face. In the 1900s, when orthodontics was established as a specialty, treatments were planned primarily to achieve an ideal occlusion, according to ‘Angle's hard tissue paradigm’; however, in recent years, the ‘soft tissue paradigm’ focusing on the treatment of facial soft tissues in dentofacial problems has started to be accepted in orthodontics and orthognathic treatments. In soft tissue paradigm, primarily the adaptation and balance of facial soft tissues is aimed after surgery. In this article, a review of the literature on indications, movement capacity and effects of orthognatic surgery on soft tissues is presented.

Anahtar Kelimeler

orthognathic surgical treatment, soft tissue analysis, orthodontic treatment

Kaynakça

• 1. Wolford L, Fields R. Diagnosis and treatment planning for orthognathic surgery. Oral Maxillofac Surg.. 2000;2:24-55.
• 2. Graber LW, Vanarsdall RL, Vig KW, Huang GJ. Orthodontics-E-Book: Current Principles and Techniques 6th edition chapter 16: Elsevier Health Sciences; 2016.
• 3. Özdiler E. Güncel Bilgiler Işığında Ortodonti Bölüm 11: Gümüş Kitabevi; 2015.
• 4. Proffit WR, Fields Jr HW, Sarver DM. Contemporary orthodontics 4th edition chapter 19: Elsevier Health Sciences; 2006.
• 5. Graber LW, Vanarsdall RL, Vig KW, Xubair A. Orthodontics:Current Principles and Techniques 5th edition 25th chapter: Elsevier Health Sciences; 2011.
• 6. Proffit W, Ackerman J. A systematic approach to orthodontic diagnosis and treatment planning. Current orthodontic concepts and techniques. 1985;3.
• 7. Graber LW, Vanarsdall RL, Vig KW, Xubair A. Orthodontics:Current Principles and Techniques 5th edition 25th chapter: Elsevier Health Sciences; 2011.
• 8. Graber LW, Vanarsdall RL, Vig KW, Xubair A. Orthodontics: Current Principles and Techniques 5th edition chapter 24: Elsevier Health Sciences; 2011.
• 9. Bishara SE. Textbook of orthodontics chapter 30: WB Saunders; 2001.
• 10. McLaughlin R, Arnett G. Facial and dental planning for orthodontists and surgeons chapter 1. Mosby; 2004.
• 11. Naini FB, Gill DS. Orthognathic surgery: principles, planning and practice chapter 16: John Wiley & Sons; 2017.
• 12. Naini FB, Cobourne MT, McDonald F, Wertheim D. The aesthetic impact of upper lip inclination in orthodontics and orthognathic surgery. Eur J Orthod. 2014;37:81-6.
• 13. Kaipatur NR, Flores-Mir C. Accuracy of computer programs in predicting orthognathic surgery soft tissue response. J Oral Maxillofac Surg 2009;67:751-9.
• 14. Mobarak KA, Espeland L, Krogstad O, Lyberg T. Soft tissue profile changes following mandibular advancement surgery: predictability and long-term outcome. Am J Orthod Dentofacial Orthop. 2001;119:353-67.
• 15. Zoumalan RA, Larrabee WF. Anatomic considerations in the aging face. Facial Plast Surg. 2011;27:016-22. 16. Soncul M, Bamber MA. Evaluation of facial soft tissue changes with optical surface scan after surgical correction of Class III deformities. J Oral Maxillofac Surg 2004;62:1331-40.
• 17. Kau CH, Cronin AJ, Richmond S. A three-dimensional evaluation of postoperative swelling following orthognathic surgery at 6 months. Plast Reconstr Surg. 2007;119:2192-9.
• 18. Day CJ, Lee RT. Three-dimensional assessment of the facial soft tissue changes that occur postoperatively in orthognathic patients. World J Orthod. 2006;7.
• 19. Holty J-EC, Guilleminault C. Maxillomandibular advancement for the treatment of obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev. 2010;14:287-97.
• 20. Schendel SA, Carlotti AE. Nasal considerations in orthognathic surgery. Am J Orthod Dentofacial Orthop. 1991;100:197-208.
• 21. Altman JI, Oeltjen JC. Nasal deformities associated with orthognathic surgery: analysis, prevention, and correction. J Craniofac Surg. 2007;18:734-9.
• 22. O'Ryan F, Schendel Jr S. Nasolabial esthetics and maxillary surgery. Modern practice in orthognathic and reconstructive surgery St Louis, MO: WB Saunders. 1992:285-317.
• 23. Millard Jr DR. The alar cinch in the flat, flaring nose. Plast Reconstr Surg. 1980;65:669-72.
• 24. Howley C, Ali N, Lee R, Cox S. Use of the alar base cinch suture in Le Fort I osteotomy: is it effective? British J Oral Maxillofac Surg. 2011;49:127-30.
• 25. Dann 3rd J, Fonseca R, Bell W. Soft tissue changes associated with total maxillary advancement: a preliminary study. J Oral Surg. 1976 Jan;34:19-23.
• 26. Mommaerts MY, Lippens F, Abeloos JV, Neyt LF. Nasal profile changes after maxillary impaction and advancement surgery. J Oral Maxillofac Surg. 2000;58:470-5.
• 27. Khamashta-Ledezma L, Naini F. Systematic review of changes in maxillary incisor exposure and upper lip position with Le Fort I type osteotomies with or without cinch sutures and/or VY closures. International J Oral Maxillofac Surg. 2014;43:46-61.
• 28. Kim Y-I, Park S-B, Son W-S, Hwang D-S. Midfacial soft-tissue changes after advancement of maxilla with Le Fort I osteotomy and mandibular setback surgery: comparison of conventional and high Le Fort I osteotomies by superimposition of cone-beam computed tomography volumes. J Oral Maxillofac Surg. 2011;69:e225-e33.
• 29. Maal T, de Koning M, Plooij J, Verhamme L, Rangel F, Bergé S, et al. One year postoperative hard and soft tissue volumetric changes after a BSSO mandibular advancement. International J Oral Maxillofac Surg 2012;41:1137-45.
• 30. Joss CU, Joss-Vassalli IM, Kiliaridis S, Kuijpers-Jagtman AM. Soft tissue profile changes after bilateral sagittal split osteotomy for mandibular advancement: a systematic review. J Oral Maxillofac Surg 2010;68:1260-9..
• 31. Behrents RG. Growth in the aging craniofacial skeleton: Center for Human Growth and Development, University of Michigan; 1985.
• 32. Joss CU, Joss-Vassalli IM, Bergé SJ, Kuijpers-Jagtman AM. Soft tissue profile changes after bilateral sagittal split osteotomy for mandibular setback: a systematic review. J Oral Maxillofac Surg 2010;68:2792-801.
• 33. McDonnell J, McNeill R, West R. Advancement genioplasty: a retrospective cephalometric analysis of osseous and soft tissue changes. J Oral Surg 1977;35:640-7.
• 34. Reddy PS, Kashyap B, Hallur N, Sikkerimath B. Advancement Genioplasty-Cephalometric Analysis of Osseous and Soft Tissue Changes. J Maxillofac Oral Surg. 2011;10:288-95.
• 35. Soydan SS, Cubuk S, Pektas ZO, Uckan S. The extent of chin ptosis and lower incisor exposure changes following the osseous genioplasties. J Craniofac Surg. 2013;24:e445-e58.
• 36. Park J-Y, Kim MJ, Hwang SJ. Soft tissue profile changes after setback genioplasty in orthognathic surgery patients. J Craniomaxillofac Surg. 2013;41:657-64.
• 37. Sonego C, Bobrowski Â, Junior OC, Torriani M. Aesthetic and functional implications following rotation of the maxillomandibular complex in orthognathic surgery: a systematic review. Int J Oral Maxillofac Surg. 2014;43:40-5.
• 38. Reyneke J, Bryant R, Suuronen R, Becker P. Postoperative skeletal stability following clockwise and counter-clockwise rotation of the maxillomandibular complex compared to conventional orthognathic treatment. Br J Oral Maxillofac Surg. 2007;45:56-64.
• 39. Conley RS, Boyd SB. Facial soft tissue changes following maxillomandibular advancement for treatment of obstructive sleep apnea. J Oral Maxillofac Surg. 2007;65:1332-40.
• 40. Ryckman MS, Harrison S, Oliver D, Sander C, Boryor AA, Hohmann AA, et al. Soft-tissue changes after maxillomandibular advancement surgery assessed with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2010;137:86-93.
• 41. Li KK, Riley RW, Powell NB, Guilleminault C. Maxillomandibular advancement for persistent obstructive sleep apnea after phase I surgery in patients without maxillomandibular deficiency. Laryngoscope. 2000;110:1684-8.
• 42. BIÇAKÇI AA. Feyza HOLOĞLU, Sibel AKBULUT, Emrah SOYLU, b Nihat AKBULUT, b. Turkiye Klinikleri J Oral Maxillofac Surg-Special Topics. 2016;2:18-25.
• 43. KIZILDAĞ AC, ÇOKAKOĞLU S. Ortognatik Cerrahi Tedavi Sonuçlarının Bilgisayar Destekli Programlarla Öngörülmesi. Güncel Ortodonti ve Pedodonti Çalışmaları. Akademisyen Yayınevi. 2020;65-74.
• 44. Cunha HS, da Costa Moraes CA, Dornelles RdFV, da Rosa ELS. Accuracy of three-dimensional virtual simulation of the soft tissues of the face in OrtogOnBlender for correction of class II dentofacial deformities: an uncontrolled experimental case-series study. Oral Maxillofac Surg. 2020:1-17.
• 45. Elshebiny T, Morcos S, Mohammad A, Quereshy F, Valiathan M. Accuracy of three-dimensional soft tissue prediction in orthognathic cases using dolphin three-dimensional softwareJ Craniofac Surg. 2019;30:525-8.
• 46. Olivetti EC, Nicotera S, Marcolin F, Vezzetti E, Sotong J, Zavattero E, et al. 3D Soft-tissue prediction methodologies for orthognathic surgery—A literature review. Appl Sci. 2019;9:4550.
• 47. Koh CH, Chew MT. Predictability of soft tissue profile changes following bimaxillary surgery in skeletal class III Chinese patients. J Oral Maxillofac Surg 2004;62:1505-9.
• 48. Baik H-S, Kim S-Y. Facial soft-tissue changes in skeletal Class III orthognathic surgery patients analyzed with 3-dimensional laser scanning. Am J Orthod Dentofacial Orthop. 2010;138:167-78.