Influences on Stability Following Orthognathic Surgery

描述(申请人提供)：患者寻求牙面部畸形的治疗，期望他们的口腔功能、美观和口腔健康得到改善，并希望他们的生活质量将因治疗而提高。这一项目的发现通过定量记录用于治疗牙面部不和谐的各种正颌外科手术程序和固定方法的稳定性和临床可接受性，使牙面部不和谐的治疗取得了重大进展。然而，即使有了这些进展，1)在5%到20%的患者中，手术后和治疗后的形态变化在临床上是不可接受的。术后发生的髁状突和局部骨骼适应性的定位，以及这些适应性的影响和呈现的临床特征，程序和/或人口统计学因素对治疗结束和治疗完成后的骨骼结果的影响尚未确定；2)几乎100%接受下颌骨截骨手术的患者在手术后短期内经历神经感觉改变，平均两年后神经感觉评估的定量指标将无法恢复到基线值。虽然“手术创伤”通常被认为是原因，但下颌骨形态和/或固定螺钉的放置也可能是重要的促成因素；3)正颌手术后患者仍然经历着漫长而不舒服的恢复期，且费用高昂，使许多患者无法获得治疗。在本项目期间，我们将继续使用系统的、基于方案的、前瞻性的观察性研究设计，使用ConeBeamCT的纵向定量三维分析。具体目标1旨在评估潜在的预测因素(人口学、呈现的临床特征、手术类型、手术前后的髁突形态和位置，以及骨骼模型的局部区域)，这些因素是临床观察到的位置骨骼适应随时间变化的基础。具体目的2旨在评估下颌骨形态和固定螺钉放置对手术后感觉改变的影响。具体目标3旨在评估一种新的治疗干预措施--临时骨骼支抗，它比单颌截骨作为治疗特定牙面部不和谐的替代方法成本更低，需要的恢复时间更短。来自这三个特定目标的临床数据将通过改善正颌外科的临床决策和治疗计划，并通过增强患者做出知情治疗选择的能力，来推进我们提高牙面畸形患者治疗质量的最终目标。

DESCRIPTION (provided by applicant): Patients seek treatment for dentofacial deformity with the expectation that their oral function, esthetics, and oral health will be improved and that their quality of life will be enhanced as a result of treatment. Findings from this project have led to significant progress in the treatment of dentofacial disharmony by quantitatively documenting the stability and clinical acceptability of various orthognathic surgery procedures and fixation methods used to treat dentofacial disharmonies. However, even with these advances, 1) clinically significant unacceptable post-surgery and post-treatment morphological changes occur in 5 to 20 percent of patients. The localization of the condylar and regional skeletal adaptations that occur after surgery and the effect of these adaptations and presenting clinical characteristics, procedural and/or demographic factors on the skeletal results at the end of treatment and after treatment is complete have not yet been characterized; 2) virtually 100% of patients who have a mandibular osteotomy experience a neurosensory alteration in the short-term after surgery and, on average, quantitative measures of neurosensory assessment will not have returned to baseline values by two years. Although "surgical trauma" is generally cited as the cause, mandibular morphology and/or fixation screw placement may also be significant contributing factors; and 3) patients still experience a lengthy and uncomfortable recovery period following orthognathic surgery and the cost puts treatment out of reach for many patients. During this project period we will continue our use of the systematic, protocol-based, prospective observational study design using longitudinal quantitative three dimensional analyses of ConeBeamCTs. Specific Aim 1 is intended to assess the potential predictors (demographic, presenting clinical characteristics, type of surgery, pre and post-surgery condylar morphology and position, and regional areas of skeletal modeling) that underlie the clinically observed variation in positional skeletal adaptation over time. Specific Aim 2 is intended to assess the effect of mandibular morphology and fixation screw placement on post-surgical sensory alteration. Specific Aim 3 is intended to assess an emerging treatment intervention, Temporary Skeletal Anchorage, that is less costly and requires less recovery time than single jaw osteotomy as an alternative approach to treatment for specific dentofacial disharmonies. The clinical data from these three specific aims will advance our ultimate goal of improving the quality of treatment for patients with dentofacial deformities by improving clinical decision making and treatment planning for orthognathic surgery and by enhancing the ability of patients to make informed treatment choices.