ORTOGNATİK CERRAHİ TEDAVİDE ÖNCE CERRAHİ (ÖC) YAKLAŞIMI

Yıl 2019, Cilt: 46 Sayı: 1, 45 - 52, 01.04.2019

Sevil Akkaya , Amir Mamusha

Öz

Son zamanlarda, öncelikli kaygıları estetik ve sınırlı zamanı olan ortognatik cerrahi hastalarının sayısı artmıştır. Geleneksel ortognatik cerrahi tedavilerinde genelde cerrahi öncesi ortodontik tedavi uzun sürmekle beraber cerrahi sonrası 7-12 ay arasında sürmekte; hayat kalitesi de ciddi anlamda bozulmaktadır. Son dönemde,
ortognatik cerrahi tedavi konseptleri yeniden ve derinden gözden geçirilmiştir. Özellikle, cerrahi öncesi ortodontik hazırlık süreci, cerrahi ve genel olarak cerrahi sonrası kalıcı ortodontik tedavinin stabilitesi gibi faktörler, cerrahi operasyon zamanlaması açısından yeni akımlar ortaya çıkarmıştır 1. Cerrahi öncesi yapılan dekompanzasyon tedavisi tedaviyi uzatmakta ve yapılan son çalışmalarda, dekompanzasyonun fayda/zarar oranı ciddi anlamda sorgulanmaktadır. Diğer taraftan, önce cerrahi işlem gerçekleştirilirse, total tedavi zamanı önemli ölçüde azalmakta ve iskeletsel sorun baştan çözümlenmekte olacağından hasta konforu ve genel hasta memnuniyeti de önemli düzeyde artacaktır. Bundan daha da önemli olan, ortodonti alanında ‘önce cerrahi’ her geçen gün daha fazla yaygınlaşmakta ve kabul görmektedir. Bu derlemenin amacı; ortognatik cerrahi alanında uygulanmaya ve yaygınlaşmaya başlamış olan ‘Önce Cerrahi (ÖC)’ yaklaşımı hakkında bilgi vermek, endikasyonları/ kontrendikasyonları, sınırlamaları ve konu ile ilgili yapılan güncel çalışmalardan bahsetmektir.

Anahtar Kelimeler

Ortodonti, Ortognatik cerrahi, Önce cerrahi yaklaşımı

'Surgery First' (SF) approach in Orthognatic Surgery

Öz

Recently the number of the orthognatic patients with aesthetic concern priorities and limited time has increased. In conventional orthognatic surgical interventions, pre-surgical orthodontic treatment takes long time, the orthodontic treatment after surgery last from 7 to 12 months; which significantly decreases the health quality of the patients. Nowadays the concepts of the orthognatic surgery have been deeply reviewed. Taking into consideration factors like the stability of orthognatic and orthodontic results, in the terms of time there have been introduced new concepts. Pre-surgical decompensation treatment takes time and according to the recent studies, the benefit/loss ratio has been questioned. On the other hand if the surgical procedure is done at the beginning, the total treatment time is decreased and the patient's general satisfaction is increased. More importantly, the Surgery First (SF) approach is widespread and accepted in the orthodontic field. The purpose of this review is to give information about the SF - recent approach applied in orthognatic surgery; indication and contraindication and limitations. 

Anahtar Kelimeler

orthodontics, orthognatic surgery, surgery first approach

Kaynakça

• Hernández-Alfaro F, Guijarro-Martínez R, Molina-Coral A, Badía-Escriche C. Surgery first” in bimaxillary orthognathic surgery. Journal of Oral and Maxillofacial Surgery 2011;69:e201-e207.
• Hernández-Alfaro F, Guijarro-Martínez R. On a definition of the appropriate timing for surgical intervention in orthognathic surgery. International journal of oral and maxillofacial surgery 2014;43:846-855.
• Kim JH, Mahdavie NN, Evans CA. Guidelines for “surgery first” orthodontic treatment. Orthodontics-basic aspects and clinical considerations. New York: InTech Publishing 2012:265-300.
• Hullihen SP. Surgical correction of extreme protrusion of the mandible. Am. ID Sc 1849:157-165.
• Trauner R, Obwegeser H. The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. I. Surgical procedures to correct mandibular prognathism and reshaping of the chin. Oral Surg Oral Med Oral Pathol 1957;10:677-689
• Obwegeser HL. Surgical correction of small or retrodisplaced maxillae. The "dish-face" deformity. Plast Reconstr Surg 1969;43:351- 365.
• Kondo E, Aoba TJ. Nonsurgical and nonextraction treatment of skeletal Class III open bite: its long-term stability. Am J Orthod Dentofacial Orthop 2000;117:267-287.
• Kondo E, Arai S. Nonsurgical and nonextraction treatment of a skeletal class III adult patient with severe prognathic mandible. World J Orthod 2005;6:233-247.
• Aziz SR. Simon P. Hullihen and the origin of orthognathic surgery. J Oral Maxillofac Surg 2004;62:1303-1307.
• O'Brien K, Wright J, Conboy F, Appelbe P, Bearn D, Caldwell S et al. Prospective, multicenter study of the effectiveness of orthodontic/orthognathic surgery care in the United Kingdom. American Journal of Orthodontics and Dentofacial Orthopedics 2009;135:709-714.
• Luther F, Morris D, Hart C. Orthodontic preparation for orthognathic surgery: how long does it take and why? A retrospective study. British Journal of Oral and Maxillofacial Surgery 2003;41:401-406.
• Hernández-Alfaro F, Guijarro-Martínez R, Peiró-Guijarro MA. Surgery first in orthognathic surgery: what have we learned? A comprehensive workflow based on 45 consecutive cases. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 2014;72:376-390.
• Villegas C, Uribe F, Sugawara J, Nanda R. Expedited correction of significant dentofacial asymmetry using a "surgery first" approach. J Clin Orthod 2010;44:97-103.
• Brachvogel P, Berten J, Hausamen J. [Surgery before orthodontic treatment: a concept for timing the combined therapy of skeletal dysgnathias]. Deutsche Zahn-, Mund-, und Kieferheilkunde mit Zentralblatt 1990;79:557- 563.
• Nagasaka H, Sugawara J, Kawamura H, Nanda R. "Surgery first" skeletal Class III correction using the Skeletal Anchorage System. J Clin Orthod 2009;43:97-105.
• Yu C-C, Chen P-H, Liou E, Huang C-S, Chen Y-R. A Surgery-first approach in surgicalorthodontic treatment of mandibular prognathism—a case report. Chang Gung Med J 2010;33:699-705.
• Liou EJ, Chen P-H, Wang Y-C, Yu C-C, Huang C, Chen Y-R. Surgery-first accelerated orthognathic surgery: postoperative rapid orthodontic tooth movement. Journal of Oral and Maxillofacial Surgery 2011;69:781-785.
• Liou EJ, Chen P-H, Wang Y-C, Yu C-C, Huang C, Chen Y-R. Surgery-first accelerated orthognathic surgery: orthodontic guidelines and setup for model surgery. Journal of Oral and Maxillofacial Surgery 2011;69:771-780.
• Dowling P, Espeland L, Krogstad O, Stenvik A, Kelly A. Duration of orthodontic treatment involving orthognathic surgery. The International journal of adult orthodontics and orthognathic surgery 1998;14:146-152.
• Frost H. The biology of fracture healing: An overview for clinicians. Part I. Clinical orthopaedics and related research 1989;248:283-293.
• Baek S-H, Ahn H-W, Kwon Y-H, Choi J-Y. Surgery-first approach in skeletal class III malocclusion treated with 2-jaw surgery: evaluation of surgical movement and postoperative orthodontic treatment. Journal of Craniofacial Surgery 2010;21:332-338.
• Choi JW, Lee JY, Yang SJ, Koh KS. The reliability of a surgery-first orthognathic approach without presurgical orthodontic treatment for skeletal class III dentofacial deformity. Annals of plastic surgery 2015;74:333-341.
• Uribe F, Janakiraman N, Shafer D, Nanda R. Three-dimensional cone-beam computed tomography-based virtual treatment planning and fabrication of a surgical splint for asymmetric patients: Surgery first approach. American Journal of Orthodontics and Dentofacial Orthopedics 2013;144:748-758.
• Hsu SS-P, Singhal D, James J, Gateno J, Lin C-H, Huang C-S et al. Planning the SurgeryFirst Approach in Surgical-Orthodontic Treatment with a Computer Aided Surgical Simulation (Cass) Planning Protocol. 中華民國 齒顎矯正學雜誌 2012;24:24-37.
• Kaplan D, Mayer J, Ball D, McCassie J, Allen A, Stenhouse P. Fundamentals of biodegradable polymers. Biodegradable polymers and packaging 1993:1-43.
• Ko EW-C, Lin SC, Chen YR, Huang CS. Skeletal and dental variables related to the stability of orthognathic surgery in skeletal Class III malocclusion with a surgery-first approach. Journal of Oral and Maxillofacial Surgery 2013;71:e215-e223.
• Kim J-Y, Jung H-D, Kim SY, Park H-S, Jung Y-S. Postoperative stability for surgery-first approach using intraoral vertical ramus osteotomy: 12 month follow-up. British Journal of Oral and Maxillofacial Surgery 2014;52:539-544.