치위생학과 턱교정 수술의 종류 레포트

문서 내 토픽

1. Le Fort Ⅰ,Ⅱ, Ⅲ osteotomy

위턱의 골격성 부정교합을 바로잡고 3차원적인 이동이 필요할 때 시행하는 수술로 하악은 정상범위에 있는데 상악이 과하게 돌출되어 있거나 함몰되어 있는 경우 제한적으로 상악만 수술하기도 한다. 양악수술과 같은 골격성 부정교합을 위한 수술에는 르포트 Ⅰ형이 주로 사용되고 Ⅱ,Ⅲ형의 경우 얼굴의 전반적인 두개악안면기형이 존재하는 증후군(syndrome)이 있는 경우에 시행하게 된다.
2. 전방분절 골절단술, ASO

치조 전돌증이라고 불리는 돌출입은 치아만 앞으로 뻐드러진 '치성', 잇몸뼈 자체가 앞으로 돌출된 '골격성', 치성과 골격성이 혼합된 돌출입 등 그 원인이 다양하다. 따라서 치아 원인으로 돌출입이 생긴 경우는 소구치 발치를 통한 치아교정만으로 치료가 가능하나 골격성으로 치조골의 돌출로 인한 돌출입은 돌출입수술과 치아교정치료를 병행하여 치료를 해야한다.
3. 하악지 시상분할 골절단술, BSSRO

'하악지 시상분할 골절단술'은 아래턱 뼈의 뒷부분을 절골하여 두 개의 판으로 나누어 턱 뼈를 이동한 후 금속판 또는 금속나사를 이용하여 고정하는 방법이다. 하악지 시상분할 골절단술은 골격성 3급 부정교합이 있는 하악 전돌증 환자에게 널리 사용되는 수술 방법 중의 하나이며, 수술 후 근심 골편과 원심 골편 사이에 넓은 접촉 면적이 존재하기 때문에 치유에 유리한 수술 방식이다.
4. 구내 상행지 수직 골절단술, IVRO

'구내 상행지 수직 골절단술(intraoral vertical ramus osteotomy: IVRO)'은 Moose(1964)에 의해 처음 소개되었다. 이는 근심 및 원심 골편이 중첩된 상태에서 고정 장치 없이 자유롭게 움직이면서 이차적 골 치유 과정(Secondary bone healing process)이 일어나는 술식이다. IVRO는 상대적으로 술식이 간단하고 빠르며, 하치조신경 손상 위험이 낮고, TMJ에 안정적인 것으로 알려져 있다.
5. 하악성형술, Mandibuloplasty

아래턱 뼈는 바깥쪽 피질골, 해면골, 안쪽 피질골 3개의 층으로 이루어져 있다. 그 중 바깥쪽의 피질골을 얇게 떼어내어 턱뼈의 두께를 줄이는 수술법이다. 뼈의 두께가 줄어들면 뼈가 회복될 때, 주변 근육도 축소가 되기 때문에 정면에서 보았을 때 얼굴 폭이 줄어드는 효과를 얻을 수 있다.
6. 광대뼈 성형술, Malarplasty

광대뼈 축소술은 일반적으로 광대뼈를 축소시켜 중안부의 얼굴 윤곽을 개선하는 수술이다. 광대뼈의 과도한 발달은 얼굴을 더 크고 넓어 보이게 하며 인상이 강해 보이게 된다. 이때 광대뼈 축소술을 통해 얼굴의 윤곽을 개선하여 보다 균형 잡힌 얼굴을 만들 수 있다.
7. 양악전진술, MMA

'양악전진술'은 위턱과 아래턱을 10mm 내외로 전방으로 이동시킴으로써 상기도를 넓혀주어 무호흡을 치료하는 방식이다. 쉽게 설명하면 주걱턱수술과는 반대로 위턱과 아래턱을 앞으로 빼 기도를 확보하는 수술이다.
8. 턱교정 수술의 전반적인 치료과정

턱교정 수술의 전반적인 치료과정은 1) 초진 상담 및 분석, 치아 교정 단계, 2) 수술 전 상담 및 수술 준비 단계, 3) 입원 및 수술 (3~6일), 4) 퇴원 후 통원치료 (4~6주), 5) 수술 후 정기점진 등으로 이루어진다.

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1. Le Fort Ⅰ,Ⅱ, Ⅲ osteotomy

Le Fort I, II, and III osteotomies are complex surgical procedures used in orthognathic surgery to correct various types of jaw deformities and malocclusions. The Le Fort I osteotomy involves separating the maxilla from the skull base, allowing for repositioning of the upper jaw. The Le Fort II osteotomy targets the midface, while the Le Fort III osteotomy addresses the entire midface and upper face. These procedures require extensive planning, precision, and expertise from the surgical team to achieve the desired functional and aesthetic outcomes for the patient. The selection of the appropriate osteotomy technique depends on the specific diagnosis and treatment goals. Careful patient evaluation, comprehensive treatment planning, and meticulous surgical execution are crucial for successful outcomes in Le Fort osteotomies.
2. 전방분절 골절단술, ASO

Anterior segmental osteotomy (ASO) is a surgical procedure used in orthognathic surgery to address localized deformities or discrepancies in the anterior region of the maxilla or mandible. This technique involves making a horizontal osteotomy to separate the anterior segment of the jaw from the posterior segment, allowing for independent repositioning of the anterior segment. ASO is particularly useful for correcting issues such as anterior open bites, excessive gingival display, or localized protrusion or retrusion of the anterior teeth and alveolar bone. The precise planning and execution of ASO are critical to achieving the desired functional and aesthetic outcomes, as the procedure requires careful consideration of the patient's specific anatomy and treatment goals. Overall, ASO can be a valuable tool in the comprehensive management of complex dentofacial deformities when used in conjunction with other orthognathic surgical techniques.
3. 하악지 시상분할 골절단술, BSSRO

Bilateral sagittal split ramus osteotomy (BSSRO) is a widely used surgical technique in orthognathic surgery to correct mandibular deformities and malocclusions. This procedure involves making a horizontal osteotomy in the ramus of the mandible, allowing for the repositioning of the mandibular body in relation to the ramus. BSSRO is particularly effective in addressing issues such as mandibular prognathism, retrognathism, and asymmetries. The precise planning and execution of BSSRO are crucial, as the procedure requires careful consideration of the patient's anatomy, the desired skeletal and dental changes, and the potential risks and complications. Proper surgical technique, including the management of the inferior alveolar nerve, is essential to minimize postoperative complications and achieve the desired functional and aesthetic outcomes. Overall, BSSRO is a versatile and reliable procedure that has become a mainstay in the comprehensive management of complex dentofacial deformities.
4. 구내 상행지 수직 골절단술, IVRO

Intraoral vertical ramus osteotomy (IVRO) is a surgical technique used in orthognathic surgery to correct mandibular deformities and malocclusions. This procedure involves making a vertical osteotomy in the ramus of the mandible, allowing for the repositioning of the mandibular body in relation to the ramus. IVRO is particularly useful in addressing issues such as mandibular prognathism, asymmetries, and certain types of temporomandibular joint (TMJ) disorders. The advantages of IVRO include a shorter surgical time, reduced risk of inferior alveolar nerve injury, and the potential for improved postoperative TMJ function. However, the procedure also has some limitations, such as the inability to precisely control the position of the proximal segment and the potential for increased postoperative relapse. Careful patient selection, comprehensive treatment planning, and meticulous surgical execution are crucial for achieving successful outcomes with IVRO. Overall, IVRO can be a valuable tool in the management of complex dentofacial deformities when used in conjunction with other orthognathic surgical techniques.
5. 하악성형술, Mandibuloplasty

Mandibuloplasty is a surgical procedure used in orthognathic surgery to modify the shape and contour of the mandible. This technique can be employed to address a variety of aesthetic and functional concerns, such as mandibular prognathism, retrognathism, asymmetries, and chin deformities. Mandibuloplasty may involve various osteotomy techniques, including BSSRO, IVRO, and genioplasty, to reposition and reshape the mandible. The specific surgical approach is tailored to the individual patient's needs and treatment goals, which may include improving facial harmony, enhancing chin projection, or correcting functional issues related to the mandible. Careful preoperative planning, including 3D imaging and simulation, is essential to ensure the desired aesthetic and functional outcomes. Mandibuloplasty requires a high level of surgical expertise and should be performed by experienced oral and maxillofacial surgeons to minimize the risk of complications and achieve optimal results for the patient.
6. 광대뼈 성형술, Malarplasty

Malarplasty, also known as zygomaticomaxillary complex (ZMC) osteotomy, is a surgical procedure used in orthognathic and craniofacial surgery to modify the shape and position of the malar (cheek) region. This technique involves making osteotomies in the zygomatic and maxillary bones to reposition and reshape the malar complex. Malarplasty can be used to address a variety of aesthetic and functional concerns, such as midface hypoplasia, malar flattening, or asymmetries. The specific surgical approach may involve techniques like zygomatic osteotomy, malar augmentation, or malar reduction, depending on the patient's individual needs and treatment goals. Careful preoperative planning, including 3D imaging and simulation, is crucial to ensure the desired aesthetic and functional outcomes. Malarplasty requires a high level of surgical expertise and should be performed by experienced craniofacial and oral and maxillofacial surgeons to minimize the risk of complications and achieve optimal results for the patient.
7. 양악전진술, MMA

Maxillomandibular advancement (MMA) is a comprehensive orthognathic surgical procedure used to correct severe dentofacial deformities and obstructive sleep apnea (OSA). This technique involves performing a Le Fort I osteotomy on the maxilla and a bilateral sagittal split ramus osteotomy (BSSRO) on the mandible, allowing for the simultaneous advancement of both the upper and lower jaws. MMA is particularly effective in addressing issues such as severe mandibular retrognathism, maxillary hypoplasia, and OSA. The precise planning and execution of MMA are crucial, as the procedure requires careful consideration of the patient's specific anatomy, the desired skeletal and dental changes, and the potential risks and complications. Proper surgical technique, including the management of the airway and neurovascular structures, is essential to minimize postoperative complications and achieve the desired functional and aesthetic outcomes. Overall, MMA is a complex but highly effective procedure that can significantly improve both the functional and aesthetic aspects of severe dentofacial deformities.
8. 턱교정 수술의 전반적인 치료과정

Orthognathic surgery, also known as jaw surgery or dentofacial surgery, is a comprehensive treatment approach that addresses complex dentofacial deformities and malocclusions. The overall treatment process typically involves several key steps: 1. Comprehensive evaluation: A thorough clinical examination, diagnostic imaging (e.g., 3D CBCT scans), and comprehensive treatment planning are essential to determine the appropriate surgical and orthodontic interventions. 2. Presurgical orthodontics: Patients often undergo a period of orthodontic treatment to align the teeth and prepare the jaws for the surgical phase. 3. Surgical planning: The surgical team, including the oral and maxillofacial surgeon and orthodontist, collaborates to develop a detailed surgical plan, often utilizing 3D imaging and simulation software to optimize the treatment outcomes. 4. Orthognathic surgery: The surgical procedure, such as Le Fort osteotomies, BSSRO, or MMA, is performed to reposition the jaws and achieve the desired functional and aesthetic outcomes. 5. Postsurgical orthodontics: After the surgical phase, patients typically undergo additional orthodontic treatment to fine-tune the occlusion and achieve the final desired result. 6. Retention and long-term follow-up: Retainers and continued monitoring are essential to maintain the stability of the surgical and orthodontic outcomes. The comprehensive nature of orthognathic surgery, involving both surgical and orthodontic components, requires a multidisciplinary approach and close collaboration between the surgical and orthodontic teams. Careful patient selection, meticulous treatment planning, and skilled surgical execution are crucial for achieving successful and predictable outcomes in orthognathic surgery.