The Clinical Study Of Mandibular Protrusion Deviation Treated With Orthadontic And Orthgnathic Treatment

BACKGROUND:The mandibular protrusion deviation is a common disease. But there still exist some problems when remedying this deformity in clinical work. Relapse is the most common complication after treatment. According to the clinical report, the rate of relapse is very high. In the mean time, because the clinical display of this kind of disease is very complicate, how to diagnose, devise and remedy correctly is very difficult and very important. The surgical complication of this deformity is very common too, some of them once occur, they could bring very bad results. So we do this retrospective study, and provide some maybe usefull experiences for clinical work.OBJECTIVES:In oder to find the best treatment method of this kind of deformity,to study the factors of the relapse and to conclude the clinical experience, seventy patients with mandibular protrusion deviation from Guang Dong Province Stamotogical Hospital were retrospectively studied.METHODS:All surgical operations were did by three experts of surgery. In the seventy patients, the male number was twenty- nine, the female number was forty-one, the age was from eighteen to thirty-eight, the mean age was twenty-four. All patients were consulted by orthodontic and orthognathic doctors before treatment. The number of patients, deviation was over 3mm. All patients were did orthodontic treatment before and after orthognathic operation. The period of orthodontic treatment before operation was from six to eighteen months, and that after operation was from four to twevle months.In order to realize the factors which relative to the relapse and to explore the method which can decrease the relapse, cepha]ometric was done one week after operation and three month after the treatment was over, and divided the the group in according to the number of mandibuar retrograde. The statistical analysis was finished on the SPSS13 software.In order to found the best treatment way of this kind of deformity and to study the factors which can effect the appearance of the patients, the methods of operation were statistcal and analysed.In order to explore the reasons of complication and to study the precautionary method, the main complication were statistical and analysed, and provided some maybe useful1 ways.RESULTS: All patients have some degrees of relapse. The cephalometric analysis displayed that the mean relapse was 1.86mm, the relapse in the group whose retrograde of mandibular over 8mmwas 1.94mm, and that in the group whose retrograde lower 8mmwas 1.78mm. Normal facial appearance and occlusal plane and masticatoryfunction were restored in 68 cases of the patients. In according to the condition of patients, different methods of operation were adopted. 19 patients were adopted intraoral sagittal split ramus oseteotomy, 25 patients were adopted intraoral sagittal split ramus oseteotomy and genioplasty, 15 patients were adopted intraoral sagittal split ramus oseteotomy and LeFort I ostectomy, 11 patients were adopted intraoral sagittal split ramus oseteotomy, LeFort I ostectomy and genioplasty.The main complications of these patients were the mandibular fracture , the unnormal feeling and numbness of lower lip, although we fiound no mandibular alveolar nerve damage in operation.CONCLUSIONS:The patients have some certain degree relapse after treatment, but the little relapse make no effects on the apperence of the patients. The thorough orthodontic treatment before operation can make up with the relapse of operation. How to maintain the propper opsition of the condyle in the operation, how to decrease the effect of the condyle in the rigid fixation and the orthodontic treatment before and after operation were the most important factors which effect the relapse.Because the conditions of patients were very complicated, the diagnosis, the device and the treatment must be done carefully. If the patients have soft tissue deformity, twice operation should be selected. Different methods of operation should be adopted in according to the different condition of patients. Only do we like this, we could achieve better results.In regard to the factors of mandibular fracture in the intraoral sagittal split ramus osteotomy, there was anatomic factors and there maybe the doctors did not well in the operation, but if we deal with it very carefully, the occurrence of this kind of complication is very low. The unnormal feeling and numbness of lower lip was very common after operation, but if the mandibular alveolar never was not damaged in the operation, the feeling of the low lip can restore in the end.The clinical condition of the maxillofacial asymmetry deformities was very complicated, if we want to achieve better clinical effect, we should select the treatment carefully and properly.