手術治療策略與力學重建：

經 3D 電腦斷層影像分析與數位手術模擬（VSP），針對此類拔牙代償後的二次矯正難題，我們制定了單純手術方案（Surgery-Only Orthognathic Surgery），直接在骨骼層面進行精準重整：

1.     雙顎正顎手術（Two-Jaw Orthognathic Surgery）：

o   透過上顎 Le Fort I 截骨前移以支撐中臉凹陷，配合下顎 BSSO 進行旋轉後退與對稱校正。

o   導入咬合平面順時針旋轉（Clockwise Rotation of Occlusal Plane）：提升上顎前牙顯露量（Incisal show）、重建具美感的弧形微笑曲線（Smile arc），並改善靜態嘴角下垂。

o   重新校正中線，並刻意在術中設定適度 Overjet，建立更穩定的前牙導引與深覆咬基礎。

2.     顏面輪廓精準修飾（Facial Bone Contouring）：

o   複合顴骨截骨術（Zygoma reduction）、下顎骨角成形術（Mandibuloplasty）與下巴截骨成形術（Genioplasty），有效縮減面寬與下顏面長度，修飾整體線條流暢度。

臨床結果與觀察：

患者術後不僅面部比例達到緊緻、立體與平衡，更在未進行二次齒列矯正的前提下，主觀感受咬合穩定度與咀嚼機能皆較術前提升。此案例驗證了針對掩飾性矯正後的複合型骨骼問題，精準的 3D 骨骼重塑與咬合平面旋轉能提供可靠的解方。

Clinical Case Study: Surgical Correction and Profile Harmony in a Post-Camouflage Skeletal Class III Patient via Surgery-Only Protocol

Managing skeletal Class III malocclusions exclusively through extraction-based camouflage orthodontics often results in compromised facial aesthetics despite achieving dental Class I occlusal parameters.

Case Background & Clinical Dilemma: A young female patient presented following extensive orthodontic camouflage involving four premolar extractions. While her anterior dentition was retracted into a pseudo-Class I relationship, substantial skeletal and aesthetic deficiencies persisted:

·       Severe midface hypoplasia and persistent skeletal Class III concave profile with increased lower facial height.

·       Mandibular asymmetry with dental midline shift to the right and shallow overbite/overjet.

·       Inverted or flat smile arc, resting downturned oral commissures, and dynamic smile asymmetry.

Surgical Design & Digital Treatment Planning: Given the patient’s desire to avoid secondary comprehensive orthodontics, a Surgery-Only Two-Jaw Orthognathic Approach combined with facial contouring was executed using advanced 3D Virtual Surgical Planning (VSP):

·       Bimaxillary Repositioning & Clockwise Rotation: Maxillary Le Fort I advancement restored paranasal projection, while the mandibular bilateral sagittal split osteotomy (BSSO) addressed asymmetry and midline discrepancy. Strategic clockwise rotation of the maxillomandibular complex corrected the occlusal plane inclination, optimizing incisal show, restoring the consonant smile arc, and elevating oral commissures.

·       Controlled Overjet Configuration: A deliberate anterior clearance was engineered surgically to establish stable functional guidance.

·       Multidimensional Facial Contouring: Simultaneous zygomatic reduction, mandibular angle recontouring, and genioplasty were integrated to shorten lower face height, narrow the facial frame, and establish balanced facial contours.

Postoperative Outcome: The patient achieved superior functional stability and enhanced chewing comfort immediately post-surgery without secondary orthodontic intervention, alongside substantial improvement in three-dimensional facial balance.