Insights

The Paradigm Shift of Orthognathic Surgery Kuhn coined the term "paradigm shift" in 1962 to describe scientific discoveries that subvert previous knowledge and are difficult to ignore. When such a "shift" occurs, all previous guidelines for a given treatment are rewritten and replaced by new insights and rules. In the history of orthognathic surgery, the first paradigm shift appeared in 1967: Hugo Obwegeser published sagittal split ramus osteotomy (SSRO), which allowed orthognathic surgery not only to treat prognathia, but also to treat retrognathia, laterognathia, etc. with the new surgical method. Later, people such as David Hall, Roger West, Bruce Epker, Larry Wolford, and William Bell began to pioneer maxillary correction surgery. After a better understanding of the 3D structure of maxillofacial bone abnormalities, 2-jaw surgery gradually replaced single mandibular surgery and became the mainstream. Although the development of surgical instruments in recent years, such as internal fixation bone plates, ultrasonic osteotomies, etc., as well as the advancement of 3D imaging technology, have made orthognathic surgery safer, more efficient and more stable, the clinical challenges faced by orthodontists or surgeons are also more complex than before. In addition to occlusion and facial aesthetics, more considerations include the stability of the respiratory tract and temporomandibular joint. This report reviews the history of orthognathic surgery, looks forward to a more comprehensive outline of orthognathic-jaw correction, respiratory tract-temporomandibular joint treatment, and welcomes the arrival of the next paradigm shift!

3D planning for craniofacial surgery to current aesthetic and reconstructive surgery has been increasingly developed through last decades. Orthognathic surgery for example, we can have better accuracy during the operation so that we can make a treatment plan not only for orthognathic but also for saving space to make airway reconstruction for patients suffering from OSA. For the custom-made facial implants, Virtual Planning increased fitness of facial implants. We can have better result even in the Infraorbital Implant Surgery, which has a big demand in Taiwan. It usually needs high fitness of facial implants. It has become a helpful additional tool for clinicians to optimize surgical result through simulation and increased visualization. 在這幾十年來顱顏手術電腦3D模擬系統，應用於當前的顱顏面美學和重建手術一直在不斷發展。 以正顎手術而言，電腦3D模擬具有更好的準確性，醫師能夠在制定正顎手術治療時更準確的預留空間讓呼吸道拓寬，以改善睡眠呼吸中止症患者的困擾。在客製化臉部3D植入物方面能夠提高其吻合度，例如蘋果肌部分提供客製化3D列印下眼眶骨植入手術。這通常需要非常良好的吻合性，醫師能分析事前的數據制定出精確的手術計畫，在這類型手術中得到較好的治療成果。

In clinical practice, doctors or orthodontists face various cases of malocclusion, which are often combined with different proportions of dento-facial deformity, temporomandibular disorder (temporomandibular disorder), and even snoring and obstructive sleep apnea, which are getting more and more attention now. In the face of complex and changeable temporomandibular joint symptoms, the respiratory space and the relative How can clinicians provide safe and efficient care to patients with increasingly higher demands for facial aesthetics? treatment plan? This report will focus on surgical orthodontics, sleep apnea treatment and temporomandibular joints. Section on treatment strategies and sharing of clinical experiences and concepts.

Since Dr. Altobelli first described the basic concept of computer-assisted 3D planning for craniofacial surgery 1993, its application to current aesthetic and reconstructive surgery has been increasingly developed through last decades. Different solutions for virtual craniomaxillofacial planning are basically appropriate for routine clinical use. Orthognathic surgery, facial bone sculpture, genioplasty and custom-made facial implants are some of the most commonly applications of virtual planning to the facial aesthetic surgeon. Compared to conventional methods, virtual planning has more advantages such as better accuracy, better communication with orthodontists, decreased operation time, decreased complication and increased fitness of facial implants. It has become a helpful additional tool for clinicians to optimize surgical result through simulation and increased visualization. 自從1993年Altobelli首先提出了電腦系統輔助3D規劃顱顏面手術的基本概念後，其應用於目前的顱顏面美學和重建手術在這幾十年來一直在不斷發展。透過電腦模擬系統制定不同的治療計劃已普遍的存在於臨床應用。正顎手術、削骨手術、截骨手術和臉型客製化植入物手術是顱顏外科醫師最常應用到的範疇。與常規方法相比，電腦模擬具有更好的準確性，能與矯正醫師達到更良好的溝通，減少手術時間，減少併發症和提高臉部植入物的吻合度等優點。有了治療計畫模擬與提高多方視角的好處，電腦模擬系統已成為臨床醫師有效提升手術成果的附加工具。