骨性第三類型咬合不正合併反咬、開咬
(上顎骨發育不足、下顎骨突出)
手術計畫
3D客製化正顎(上下顎手術)
【姜厚任醫師】
這位患者是嚴重的骨性第三類型咬合不正合併反咬、開咬，臉部外觀上除了很明顯的下顎前突(mandibular prognathism)之外，
上顎骨發育也明顯不足(retrusive maxilla), 造成很大幅度的上、下顎牙齒反咬、中顏面凹陷的情況。
我們採取矯正優先的治療計畫，先進行幾個月的矯正治療將上下齒列排齊。
考量患者的牙齒咬合關係、臉部外觀比例後，
利用雙顎正顎手術將明顯前突的下顎骨縮短並且讓後縮的上顎骨大幅前進，
改善錯咬的咬合關係外也讓上、下唇位置恢復正常，改善口唇閉合不全(lip incompetence)及長期口呼吸(mouth breathing)問題。
同時，雙顎正顎手術也可以避免傳統單顎下顎手術後退可能影響上呼吸道空間的情況。
手術及齒顎矯正治療完成之後患者的咬合關係的明顯改善，原本凹陷的中臉部分也得到良好的重建跟支撐，
更開心的是上下嘴唇總算可以在放鬆的狀態下閉合，徹底改善困擾已久的咬合、呼吸及臉型外觀三個面向的問題。
This patient presented with severe Skeletal Class III Malocclusion complicated by both an anterior crossbite/underbite and an open bite.
Facially, the patient exhibited classic signs of the deformity:
A very prominent mandibular prognathism.
Marked maxillary hypoplasia (or retrusive maxilla).
These skeletal discrepancies resulted in a significant anterior/posterior crossbite of the upper and lower teeth, and a severe mid-facial concavity.
Treatment Strategy: Orthodontics First and Bi-Maxillary Surgery
We adopted an Orthodontics-First treatment plan, initiating several months of orthodontic therapy to align and level the upper and lower dental arches.
After comprehensive consideration of the patient's dental occlusion and facial aesthetic proportions, we utilized Bi-Maxillary Orthognathic Surgery (Double Jaw Surgery):
The significantly protrusive mandible was surgically set back.
The retrusive maxilla was simultaneously advanced significantly.
This approach not only corrected the malocclusion but also normalized the position of the upper and lower lips, effectively addressing issues of lip incompetence and chronic mouth breathing. Furthermore, Bi-Maxillary Surgery mitigates the risk of compromising the upper airway space, a potential complication often associated with traditional single-jaw mandibular set-back surgery.
Post-Treatment Outcome
Following the completion of both the surgery and the subsequent orthodontic treatment, the patient achieved a dramatic improvement in their occlusal relationship.
The previously retrusive and concave mid-face received excellent reconstruction and support.
Most notably, the upper and lower lips can finally close naturally and effortlessly when at rest.
The treatment successfully resolved the long-standing, interconnected issues across all three domains: occlusion (bite), respiration (breathing), and facial aesthetics (profile).
Copyright © 2007-2017 All Written Contents and Pictures Created by Dr. Adrian M. Hsieh and Dr. Scott H. Jiang
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手術成效因人而異，需由專業醫師評估。案例圖片經當事人授權同意公開使用做為診療的輔助說明、衛生教育及醫療知識分享，僅供參考。
