• TAP CHi NGHIEN CU'U Y HOC
KET QUA B U a C DAU DIEU TRj BENH NHAN LECH LAC XLfaNG HAM HANG III CO B A T CAN XUNG
BANG PHAU THUAT CHJNH HAM
Nguyin Thu Ha"", Le Van So'n^ Bui HOu Lam^, Bui Dang Qudc Thai^ Pham Anh Khoa*
''^••' ^Benh vien Rang Ham Mat Trung uung thanh phi Hd Chi Minh, ^Tru&ng Oai hqc Y Ha Nqi
L$ch lac xwang ham hang Ili c& bit can xung la tinh trang thwang thiy trong dan s6 va co nhu ciu diiu tri cao Tuy nhien, phiu thuat xuang ham bit can ximg phirc tqp Nghien ciru mo ta tien hanh tren 12 benh nhSn, tu6i trung binh 23,25 ± 3,11; lech lac xwang ham hang ill co bit can ximg tqi benh vi$n Rang Ham Mat Trung wang va Benh vien Tneu An thanh pho Ho Chi Mmh. dwoc dieu tri bang phau thu$t chinh ham, nhim xac dinh d$c diim lam sang. X quang benh nhan trw&c phiu thuat va danh gia thay ddi xwang - mo mem sau phiu thuat Kit qua cho thiy 11 benh nhan i&ch trai (91,67%), 01 benh nhan lech phai, thay doi tmac mo va sau mo twang irng cua goc ANB ia -4,64 ± 3, ISP va 1,30 ± 3.53° (p < 0.01), cua muc do lech vung cim tren phim so thing la 6.37 + 2.29 mm va 1.49 ± 1,06 mm (p < 0.001) va cua do can chia -5.04 ± 3,55 mm va 2mm (p < 0,001) Cac tru&ng hap lech lac xwang ham hang ill cd bit cSn ximg cd thi diiu tn hi$u qua bang phiu thuat chinh ham de cai thidn thim my va chirc nang
TO khoa: mat b i t can xOng, hang III x u a n g , che dpc canh cao, di lech Idi eau
I. DAT
VANDt
Mdt trong nhOng khd khan d i l u tri benh nhan Igch iac xuong ham hang III la eo b i t can xOng- Day eung la than philn chinh do dd benh nhan cd nhu eau d i l u tn eao. Ngoai ra, nhieu nghien cOu cho thly m l i lidn quan giua lech lac rang - mat va loan nang thai dugng ham [1] TI le b i t can xOng mat khoang 2 1 % - 85%, trong dd 48% cae trudng hap la sai khdp c l n hang III [2]. Tinh trang b i t can xOng cd the xay ra ddng thai theo ba chilu khdng gian T i n g mat dudi d l nhan thly b i t can xung han t i n g mat trdn [3]- Cdng cu dan gian va hieu qua de danh gia m i t can xOng mat la anh chup m§t thing va phim so thing (posteroantenor (PA) cephalpgram) [4]
Dia chilien h$ Nguyen Thu Ha. khoa Phau thuat Ham MSt benh vien RSng Ham MSI Trung uong. Tp HCM Email hanguyen1508@yahoo com Ngaynhan 08/11/2016 Ngay duac chip thuan 26/2/2017
Mue tigu d i l u tn bat can xOng la dudng giOa xugng ham tren - xuang ham dudi, elm triing dudng giua mat, mgp mdi can xOng hai ben, Hau h i t cac di dang rang - mat cd d l dugc d i l u tn blng ba phlu thuat chinh c i t xugng ham tren theo dugng LeFort I, che doc canh eao xuang ham dudi (Sagittal - Split Ramus Osteotomy Ramus SSRO) va tao hinh e l m d l chinh sOa b i t can xOng theo ba chilu khdng gian [5] NhOng trudng hap b i t can xung mep mdi, mat phlng nhai nghigng ra rgt, c l n phlu thuat hai ham d l sua chOa mat phlng khdp c l n Theo Chew, cd 84% benh nhan Igch lac xugng hang III ed b i t can xOng mat c l n phlu thuat hai ham [2], Tuy nhign, ddi vdl nhOng trudng hap b i t can xOng_ xuang ham dudi, khi thue hign phau thuat che doc canh eao hai ben (Bilateral Sagittal - Split Os- teotomy, BSSO) cd nguy ca gia t^ng ehan thuang t h i n kmh xugng I dudi hay di lech Idi e l u ben lech, gay ra nhung biln chOng sau
TCNCYH 106(1)-2017
TAP CHI NGHIEN CU'U Y HOC • m l nhu rdi loan cam giae, loan nang thai duong ham, anh hudng su vOng I n sau phlu thuat [6, 7] Do dd, nhilu nghidn cOu cai tiln ky thuat nhu cat bdn lech blng phugng phap c i t doc canh eao dudng trong mieng (Intraoral Vertical Ramus Osteotomy. IVRO), che doc cheo eao canh cao xugng ham dudi (The high oblique sagittal split osteotomy.
HOSSO), elt 'xuang be cong phia sau (postenor bending osteotomy PBO) [6, 8, 9].
Ngoai ra, ed the loai bd can trd xuang giOa hai dian cat xuang k i t hgp vdi dmh vi l6i e l u dCing trong hdm khdp ciing ed higu qua trong nhOng trudng hgp b i t can xOng gay biln dang ill elu hay hlnh dang xugng ham dudi VI vay, chimg tdi t i l n hanh nghign cOu nay nham muc tigu md ta dac d i l m iam sang, X quang d benh nhan lech lac ham - mat hang lil cd bit can xOng trudc phlu thuat va danh gia thay d l i xugng - md mem sau phau thuat
II. D 6 | TU'gNG VA PHU'aNG PHAP
I.Ddi tuangTieu chuan chgn benh nhan: benh nhan lech lac xugng ham hang III ed b i t can xung,
£ 18 tuli, da duac chinh nha trudc m l Lech vung elm tren phim do sg thing > 4mm [10]
Benh nhan duoc d i l u tn blng phau thuat ehe doc canh cao xugng ham dudi ed dmh vi i l l c l u , k i t hap phlu thuat LeFort I trong trudng hgp xugng ham trdn liii nhilu hay mat phlng nhai nghigng, k i t hgp phlu thuat tao hinh elm trong trudng hop qua tnen bg dudi xugng ham dudi Benh nhan ed chup phim do sp thing, so nghleng va anh chup mat thing trudc phlu thuat (TO) va sau phlu thuat (Tl) khoang 1 - 2 thang, blng may chup phim hieu Sirona - Siemen cua DOc, may chup anh hieu Nikon E5200 Nghien cuu dugc thuc hien tai
Benh vign Rang Ham Mat Trung uung vS Bgnh vi0n T r i l u An - Thanh p h i H i Chi Mmh to thang 7/2014 d i n thang 01/2016 Tat ca bgnh nhan dugc d i l u tri va thee ddi bdi mot phau thuat vien
Tieu chuan loai benh nhan: Benh nhSn cd tiln su ehln thuang ham mat. Ho sa chin doan khdng d l y du Bgnh nhan cd benh ly toan than chdng chi dinh p h i u thugt
2. P h u a n g phap
Nghien cuu iam sang md ta loat ea benh, Cac bw&c tien hanh
- Kham bgnh nhan, l l y d l u hai ham, chup phim do so t h i n g , nghigng va anh chup mSt thing, Ign k l hoach phau thuat
-Trudng hop bgnh nhan phlu thuat xuorig ham dudi b l n g phuang phap ehe doc canh cao, cd dmh vi Idi eau blng n^p thing v^
mang nhai d tuang quan trung tam' Trudc khi e l t xuang, ed dmh hai ham vdi mang nhai a vj tri tuang quan trung tam, nep - vit dmh vi to ham go ma (phln c l dmh) d i n canh cao xuang ham dugi d l ghi nhan vj tri Idi clu (phln dl ddng) Thao nep va mang nhai. Tien hanh c i t che doc xugng ham dudi, mai chinh can trd xugng giOa hai didn xuang, di chuyen xuang ham dudi sao che khdp vdi rang ham tren, dd c l n phu, can chia khoang 2 mm Trude khi k i t hap xuang, dat lai nep
•- vit dmh VI, vdi tuang quan rang d khdp cln sau ciing
- Trudng hap benh nhan cd k i t hap phlu' thuat xugng ham tren, e l t LeFort I de chinh mat phlng nhai bi nghieng va dat lai vi tri xugng ham tren ra trudc, len tren hay xudng dudi tiiy vao mOc dd Id rang cOa mong mudn
- Trudng hap benh nhan cd k i t hap tao
TCNCYH 106(1)-2017
- TAP CHI NGHIEN CU'U Y HQC hinh viing e l m , phau thuat "Genioplasty" hay
mai chinh xuang d& chinh diem giua e l m hay qua trien bd dudi xuang ham dudi
PhU'O'ng phap thu thap sd lieu - cac thdng s l danh gia: Thdng s l hgn quan d i n bgnh nhan (tuoi, gidi, t i l n sO, p h i u thuat). Thdng s l lien quan den dSc d i l m xuang, rang, md mem trudc, sau phlu thuat va k i t qua d i l u trj (SNA, SNB, ANB, OB, OJ, nghigng mat phlng nhai, mOc do lech viing elm vdi dudng giOa, so sanh mep mdi hai ben, chieu rdng gdc ham) Thdng sd lien quan bit can xOng tinh gia tci tuyet ddi, vi chl bilu thi mOc do b i t can xOng ma khdng phan bigt bgn phai hay trai
- Mat phlng va dudng thing tham chilu;
Phim sg thing dudng tham chieu ngang la dudng hen gdc m i t ngoai, dudng tham chilu dOng la dudng doe giua mat, vudng gdc dugng tham chilu ngang tai diem giOa Nghigng mat phlng nhai dudng ngang qua dinh mill hai rang nanh ham trgn Phim so nghigng. dudng tham chilu ngang (true X) la dudng thing qua S va tgo vdi SN gdc 7°, dudng tham chilu dOng (true Y) vudng gdc vdl dudng tham chilu ngang tai S
- Do dac cac thdng s l do trdn phim blng phln mIm Sidexis GX cua may chup phim higu Sirona - Siemen Cae s l do khoang each tinh bang mi-li-met va dugc qui v l kieh thudc that. Anh chup mat thing di^oc in ra gily A4, dc tl le nghigng cua mep mdi (%) [3] Lam sang do dd c l n phu, c l n chia, khoang each dilm giOa e l m d i n dudng giOa
3. X O i y sd lieu
SO dung chuang trinh Microsoft Excel 2013 va phan m I m SPSS 16.0. Phep kilm paired t test d l so sanh su khac bigt giOa hai
gia tn trung binh, Khae bi$t ed y nghTa thong kg khi p < 0,05 Sai sd trong nghien eOu: lua chgn n g i u nhien 5 trudng hgp Do Igi va so sanh giOa hai l l n do blng paired t test. T i t ca cac so do khdng cd su khac bidt
4. Dao dOc nghien cOu
Benh nhan yeu c l u cai thien thIm my va/
hoac chuc nang, benh nhan chip nhan ke hoach d i l u tri p h i u thuat sau khi da dugc giai thich d l y du Bgnh nhan hoan toan tu nguyen tham gia nghien cOu va cd quyln rut lui khdi nghien cOu b i t eu khi nao ma khdng anh hudng d i n quyln lai d i l u tn Cae thdng tin cua bgnh nhan dugc bao dam bi mat III. KET QUA
1. Dac d i l m ehung cua nhdm nghien cOu va phau thuat
Cd 11 bdnh nhan b i t can xOng lech ben trai (91,67%) va 01 Igch phai- 6 bgnh nhan mo hai ham, 6 benh nhan m l mdt ham, 5 b§nh nhan mo them vimg e l m gdm 3 benh nhan mo "genioplasty" va 2 benh nhan mai chinh xugng
2. Dac d i l m lam sang, X quang benh nhan lech lac xu'ang ham hang III cd b i t can xOng
Xugng ham tren liii ra sau (gdc SNA = 80,80 ± 2,21°), xuang ham dudi ra trudc nhilu (gdc SNB = 85,44 ± 4,66 °) MOc chenh lech giua xuang ham trdn va xuang ham dudi nhilu (gdc ANB - - 4,64 ± 3,18°) Mat phlng ham dudi md (SN - GoGn = 34,55 + 7,32 °) Dp c l n ehia (OJ) = -5,04 ± 3,55 mm Dd c l n phiJ (OB) = -1,21 ± 1,36 mm Mat phlng nhai nghieng it Lech viing d m trgn phim nhilu han md m I m tuang Ong la 5,37±
2,29 mm va 4,75 ± 2,19 mm
TCNCYH 106(1)-2017 95
TAP CHI NGHIEN CU'U Y HQC
3. K i t qua thay ddi x u a n g - mo m I m sau p h l u thuat
Bang 1. Dac d i l m x u a n g ham tren phim S9 nghieng Bi&n s6 nghien CU'U
SNA™
SN-ANS-PNS'°' SN - Occ SNB'°' SN - GoGn*"' ANB<°'
To(N=12) 80,80 ±2,21
8,38 ±3,11 14,73 ±6,67 85,44 ±4,65 34,55 ± 7,32 -4,64 ±3,18
T, (N = 12|
83,13 ±4,31 2,68 ± 4,90 15,97 ±5,98 81,83 ±3,46 35,04 ± 4,43 1,30 ±3,53
P
ns ns
...
ns
Ghi chii- ns khong khac biet co y nghla; *. khac biet co •$ nghla a mire p < 0,05. **- kh^c biel co ^ nghla a mirep < 0,01, '" khac biet co y nghla a mire p < 0,001
Sau phlu thuat SNA tang (SNA = 83.13 + 4,31°)- SNB giam nhilu (SNB = 81,83 ± 3,46", p < 0,001} Ve tugng quan hai ham, trudc phiu thuat xugng ham hang III vdi gdc ANB ia-4,64 + 3,18°, sau phau thuat xugng ham hang I vdi gdc ANB ia 1,30 ± 3,53°, khac biet ed ^ nghla amifc p < 0,01 Mdt bdnh nhan sau md ANB = 10,9° vl ke hoach phlu thugt c l n nhd nhilu ham tren de bii tru khuylt tat mdi ham I c h
15
-15 ,
Gdc ANB B i l u dd 1. Gdc AND t r u d c va sau md Bang 2. Cac sd do khoang each tren phim sg nghieng Bi^n s6
A(x) A(y) B(x) B(y) N - G n
nghien CLKU T„(N = 12) 59,61 ±4,81 52,02 ±3,19 66,10 ±10,29 89,14 ±6,90 115,93 ±8,81
T i ( N = 12) 62,25 ±6,45 53,20 + 4,42 60,93 ± 8,52 89,16 ±5,47 117,98±7,61
P
ns
...
ns ns TCNCYH 106 (1) - 2017
• TAP CHi NGHIEN CLPU Y HOC ns khdng khac biet co y nghia; **' kh^c biet co y nghla a mire p < 0,01; *"" khac biet co ^ nghTa d mire p <0,001.
A(x), B(x) Id khoing each ngang tw A, B din true Y. A(y), B(y) /a khoang c^ch dirng tir A, B den true X
Xuang ham tren phia trudc (diem A) di chuyen ra trudc trung binh la 2,64 mm, xuIng dudi trung binh la 1,18 mm Xuang ham dudi phia trudc (diem B) di chuyin ra sau trung,binh la 5,17 mm, Idn tren trung binh la 0,02 mm
Bang 3. Cac sd do cua phim do so t h i n g Bi^n s6 nghien CLPU
Tycng quan rang nanh theo mat phlng tran {%) Goc nghieng true rSng cua '°'
Lech cSm xu'ang (mm) Chl§u rong Gonion
T,(N = 12) 97,46± 0,02 1,80 ±2,41 6,37±2,29 85,18 ±5,55
T, (N = 12) 98,37 ±0,01 1,33 ±1,99 1,49 ±1,06 85,48 ±4,75
P ns ns
...
ns
ns: khong khac biet co y nghla, ***,' khac biet cd y nghla a mire p < 0,001
Tuang quan rang nanh theo mat phang tran (%) la ti lg khoang each theo chilu dOng giua rang nanh ham tren hai ben d i n dudng lign gdc m i t ngoai
Chenh lech rang nanh hai ben it eho thly mSt phlng nhai nghigng it, sau md cdn nghieng it, Dilm giOa e l m lech nhilu trude m l trung binh 6,37± 2,29 mm. Sau md, Igch it so vdi dudng giua trung binh 1,49 ± 1,06 mm (p < 0,01) Chilu rdng gdc ham hai bgn khdng thay d l i .
Bang 4. Dac d i l m khdp c l n , mOc lech vting e l m tren lam sang va nghieng mep mdi tren anh chup mat t h i n g Bi§n s6 nghien ci>u
OB (mm) 0,J (mm)
L^ch e l m mo m^m (mm) Tuong quan mep moi hai ben (%)
T „ ( N = 12) -1,21 ±1,36 -5,04±3,55 4,75 ±2,19 96,63 ±0,03
T, (N = 12) 2,04 + 0,14 2,00 ±0,00 0,54 ±0,69 98,85 ±0,01
P
...
...
...
ns ns- khong khae biBt co y nghla; "' khac biSt co y nghla d m u v p < 0.001.
Tuang quan mgp mdi hai ben (%) la ti le khoang each theo chilu dung giOa mep mdi hai bgn d i n dudng hen gdc m i t ngoai
D d c i n phu, c l n chia trudc m d a m , iin luot la -1,21 ± 1,36 mm va -5,04 ± 3,55 mm Sau mo khdp c l n vung rang cua thay doi theo k l hoach phlu thuat d l c l n phu, can chia trung binh 2 mm (p < 0,001). Truoc mo, do trgn benh nhan, d i l m giOa Igch vdi dudng giOa ia 4,75 + 2,19 mm, treng dd 01 benh nhan lech la 11 mm, 01 benh nhan lech phai la 3 mm Sau mo d i l m giua e l m gan triing vdi dudng giua (0,54 ± 0,69 mm)
TCNCYH 106(1)-2017 97
TiDiP CHI NGHIEN CU'U Y HOC •
Trudc md Sau mo
Bieu dd 2. MOc lech cam tren md mem IV. BAN LUAN
K i t qua nghign cOu eho thly dae diem lech lac xuang ham hang III trong nhdm nghien euu ed mOc dd chenh lech hai ham trim trong ngn cd bieu hign mat Idm. Nguygn nhan lech lac xuang ham hang 111 la do qua tnln xugng ham dudi t r i m trong, gdc SNB = 85,44 ± 4,66°, xugng ham tren thieu san, gdc SNA = 80,80 ± 2,21° v l dae diem khdp c l n vimg rang cOa, do c l n ehia -5,04 ± 3,55 mm, c l n phu - 1,21 ± 1,36 mm, phii hgp vdi dac d i l m dl dang rang mat d q u l n the chau A [2] Trong nghien cOu chiing tdi, gdc ANB = - 4,64 ± 3,18°, tugng duang vdi Tseng va Benyahia (2011), Idn hgn so vdi nghien cOu cua Rabie ia-2,21 ±2,51°[11].
v l dac d i l m b i t can xOng, hau h i t bdnh nhan lech trai, 11 trudng hap (91,67%), tuang duong nghien cOu cua mdt tac gia khac [3]
MOe do lech cua viing c i m tren phim so thing ia 6,37 mm, tl le chgnh lech giOa rang nanh hai bgn 97,46%; it han so vai nghign cOu cua Ko lln luat la 13,45 mm va 93,91%, cho thly nhdm bgnh nhan trong nghien cOu chiing tdi cd mat phlng nhai va Igch viing elm it han, cd the do m l u nghien cuu chiing tdi nhd.
T i t ea benh nhan d l u p h i u thuat xuang
ham dudi vi xuang ham dudi qua tnln, trong dd 50% trudng hop phau thuat hai hSm, 41,46% bd sung tao hinh e l m (gdm 5 benh nhan 3 benh nhan phlu thuat "genioplasty", 2 bgnh nhan mai xuang). Khi lap k l hoach dieu tn dat lai Vl tri xugng ham trgn, chCing tdi tiits vao mOe dd nghieng mat phlng nhai, d l sau mo mat phlng nhai song song vdi dudng ngang qua hai m i t , dua len tren hay xudng dudi met heae hai bgn la tiiy thudc mOc dd lo rang eua va rang nanh hai ben [2]- Trong nghign cOu nay, xuang ham trgn dl chuyen ra trudc trung binh 2,64 mm, xuIng dudi trung binh 1,18 mm. Nghien cOu Ko, xugng ham tren di chuyen tra trudc trung binh 1,25 mm, len tren la 1,20 mm [3] Xugng ham tren dat len trgn duae cho la vung on vl ed tilp xiic xuang, chiing tdi dat lai vi tri xuang ham tren theo hudng xudng dudi it, khoang hd thanh trude xoang ham duac ghep them xuang, de giup liln xugng nhanh, bao dam kit qua vO'ng on nen tranh dwac loan nang khdp Xuang ham dudi lui sau nhilu trung binh 5,17 mm vl trudc mo gdc SNB Idn han cac nghign ,cii'U khac [10] Gdc mat phlng ham dudi va 6Q rdng vimg gdc ham khdng thay d l i cd the do Id! c l u duac dmh vi dung, ndn khdng lam thay del VI tri d i l m Gonion
TCNCYH 106(1)-2017
• TAP CHI NGHIEN CU'U Y HOC Dieu chCi^^ trong Igch lac xuang ham cd
bat can xOng thudng la hlnh dang cua xuang ham dudi, n h l t la bd dudi xuang viing canh e l m va vung ngang thay doi c6 the do hoat ddng cua ea nang ham va ha ham khdng can xOng. Vi vay, sau khi d i l u ehinh dudng giua rang cOa ham dudi triing vdl dudng giOa mat, mdt so trudng hap c l n phai tao hlnh cam hay mai chinh them bd dudi eiia xugng ham dudi Trong nghien cOu chimg tdi, ed 5.trudng hgp c l n bd sung p h l u thuat tao hinh e l m d l d i l u chinh dudng giua elm eung nhu hinh dang xuang ham dudi can xOng hai feen Mdt sd nghien cuu diing che doe canh eao cho ben ngln va c i t dgc canh cao dudng trong mieng cho ben dai d l d l dang c i t bdt bd dudi ben dai [12]. Ca hai- phuang phap d l u eai thien duae ve ngoai cua xuang ham duai- Ngoai ra, trong p h i u thuat che dee canh cao xuang ham dudi, khi xoay manh xa khdng can xOng cd the iam xoay i l l c l u va nguy ea rdi loan cam giac ben lech hudng [10] Do do, nhilu nghien eai tiln phuang phap de han e h l nguy ea nay nhu c i t ben lech b l n g phuang phap c i t dgc canh eao dudng trong mieng, che doe cheo cao canh cao xuong ham dudi. e l t xuang be cong phia sau, loai bd can trd xuang blng cua ap dien (piezoelectric device), hay c i t xugng sigu am (ultrasonic bone device) d l tranh ton thuang t h i n kmh [6, 8; 9]. Trong nghign cOu, chung tdi mai chinh de loai bd can trd xuang d dien e l t xuang cua manh g i n , nen khdng lam ton thuang than kinh, ddng thdi dinh vi Idi c l u va cd the ghep xuang vag khoang hd phia trudc cua hai dien e l t xuang, tranh nguy ca iam xoay idi elu khi k i t hap xuang
Sau phau thuat, xuang ham eua cac benh nhan ed the cdn mat can xOng nhe, nhung ndi
chung bgnh nhan hai Idng vdi k i t qua tham chi khi cdn b i t can xOng tren 3 mm viing e l m trong 58% eac trudng hgp [10] K i t qua cua chiing tdi, d i l m giua e l m so vdi dudng giOa mat Igch khdng dgng k l (md xuong 1.49 ± 1,06 mm, md mem 0,54 ± 0,69 mm), vai bgnh nhan edn b i t can xung nhe md m I m viing canh ngang, tuy nhien t i t ca benh nhan hai Idng vdl k i t qua phlu thuat va chOc nang khdp thai duang ham khdng bi ton thuang.
V. K^T LUAN
Nghien cOu p h i u thuat chinh ham trdn 12 benh nhan lech lac ham - mat hang 111 cd b i t can xOng cho t h l y tuang quan hai ham hang 111 rd ret va hau h i t mat lech trai, mat phlng nhai nghigng it. Tat ca cac trudng hop cd p h l u thuat xugng ham dudi de ehinh sOa b i t can xOng, trcng do mdt nua cae trugng hgp cd phoi hap e l t xuang ham trgn dua ra truac va xuIng dudi, g i n phan nOa trudng hap c l n bd sung p h l u thuat d i l u chinh su can xOng diem giOa e l m va bd d u g ! xuang ham dudi Trong p h i u thuat ehe doc canh cao xuang ham dudi. c i n loai bo can trd xuong giua manh g i n va manh xa, k i t hgp vdi dinh vi l l i c l u treng liie p h i u thuat d l duy tri vi tri l l i c i u gilng nhu trudc p h l u thuat,
Lo'i c a m o r i
Xm tran trong cam on can bd nhan vign cac Khoa Phlu thuat Ham Mat, Chinh hinh Rang Mat, Gay me hdi sOc, Chan doan hinh anh Benh vien Rang Ham Mat Trung uung va Benh vign Trilu An - Thanh p h i Hd Chi Mmh da ung hd, giiip dd, tao d i l u kien de chung tdi hoan thanh nghien cOu nay Nghign cOu nay khdng duac tai trg hay phu thudc bdi cac hang cung cap thilt bi, vat t u tieu hao.
TCNCYH 106(1)-2017 99
TAP CHI NGHIEN CLfU Y HOC -
TAI LIEU THAM KHAO
1. Manfredini D., SegCi M., Arveda N et al (2016). Temporomandibular joint disorders in patients with different facial morphology, A systematic review of the literature. Journal of Oral and Maxillofacial Surgery. 74 (1), 29 - 46
2. Chew Wl.T (2006). Spectrum and man- agement of dentofaeial deformities in a multi- ethnic Asian population Angle Orthod, 76{5), 80^ - 809
3. Ko E.W.-C, Huang C.S., Chen Y.R.
(2009). Characteristics and corrective out- come of face asymmetry by orthognathic sur- gery Journal of Oral and Maxillofacial Sur- gery, 67(10), 2201 -2209
4. Song W.-C, Koh K.-S., Kim S.-H et al (2007). Horizontal angular asymmetry of the face in Korean young adults with reference to the eye and mouth Journal of Oral and Maxil- lofacial Surgery, 65 (11), 2164 - 2168
5. Patel P.K., Novia M.V. (2007). The sur- gical tools: the LeFort I, bilateral sagittal split osteotomy of the mandible, and the osseoOs genioplasty Clinics in plastic surgery. 34 (3), 447 - 475
6. Yang H.J., Hwang S.J (2014). Change in condylar position in posterior bending os- teotomy minimizing condylar torque in BSSRO for facial asymmetry Journal of Cranio- Maxillofaclal Surgery, 42(4), 325 - 332
/ . Ueki K., Moroi A., Sotobori M et al (2012). Changes m temporomandibular joint and ramus after sagittal split ramus osteotomy in mandibular prognathism patients with and
without asymmetry Journal of Cranio- Maxillofacial Surgery, 40(8), 821 - 827
8. Mohlhenrlch B.C., Kamal M., Peters F et al (2016). Bony contact area and displace- ment of the temporomandibular jpint after high -oblique and bilateral sagittal split osteotomy.
a computer-simulated comparison Br J Oral Maxillofac Surg. 54(3), 306 - 311.
9 Iwai T., Maegawa J., Aoki S et al (2013). Ultrasonic vertical osteotomy of the distal segment for safe elimination of interference between the proximal and distal segments in bilateral sagittal split osteotomy for mandibular asymmetry. British Journal of Oral and Maxillofacial Surgery, 51 (7), e192-e194
10. Hagensli N., Stenvik A., Espeland L (2014). Asymmetric mandibular prognathism;
Outcome, stability and patient satisfaction af- ter BSSO surgery A retrospective study Jour- - na! of Cranio - Maxillofacial Surgery, 42(8),
1735-1741
11. Rabie A.-B.M., Wong R.W., Min G (2008). Treatment in borderline Class III mal- occlusion- orthodontic camouflage (extrachon) versus orthognathic surgery. The open den- tistry journal. 2, 38
12. Ying B., Ye N., Jiang Y et al (2015).
Correction of facial asymmetry associated with vertical maxillary excess and mandibular prog- nathism by combined orthognathic surgery and guiding templates and splints fabncated"
by rapid prototyping technique International journal of oral and maxillofacial surgery, 44 (11), 1330-1336
TCNCYH 106(1)'2017
• — ^ — ^ - ^ ^ ^ ^ ^ - ^ ^ — ^ — ^ ^ ^ ^ ^ - ^ ^ TAP CHI NGHIEN CUU Y HOC
Summary
INITIAL EVALUATION OF CORRECTIVE OUTCOME OF SKELETAL CLASS III MALOCCLUSIONS WITH ASYMMETRY
BY ORTHOGNATHIC SURGERY
The skeletal Class III pattern with asymmetry is a relatively common condition among the population that needs intervening by orthognathic surgery The asymmetric mandibular surgery is, however, complicated. This study was conducted at National Hospital of Odonto- Stomatology and Trieu An hospital in Ho Chi Mmh City on 12 subjects with the mean age of 23,25
± 3.11 years old who suffered from skeletal class III malocclusions with asymmetry, with the purpose of determining clinical and radiographic charactenstics before surgery and evaluating soft tissue and skeletal changes after surgery The results showed that 11 patients (91 67 %) demon- strated left-side dominance and 1 patient with right-side dominance, the antero - posterior surgical changes with ANB angle was - 4-64 ± 3 18°vs 1.30 ± 3 53°(p < 0 01) respectively; the left chin deviation on postero - anterior cephalometric radiograph was 6 37 ± 2.29 mm vs 1 49 ± 1 06 mm (p < 0 001), the overjet was -5 0 4 ± 3 55 mm vs 2mm (p < 0 001) It was concluded that the condition of malocclusicn of Class III with asymmetry was considerately improved after interven- tion with orthognathic surgery to restore the patients' aesthetic facial form and functions Key words: facial asymmetry, skeletal Class III malocclusion, sagittal split ramus osteot- omy, condylar displacement
TCNCYH 106(1)-2017
