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Informationen aus Orthodontie & Kieferorthopädie 2015; 47(02): 105-116
DOI: 10.1055/s-0035-1555768
© Georg Thieme Verlag KG Stuttgart · New York

Zur Bestimmung des passenden Zeitpunktes für den chirurgischen Eingriff im Rahmen einer kieferorthopädisch-chirurgischen Behandlung[*]

On a Definition of the Appropriate Timing for Surgical Intervention in Orthognathic Surgery
F. Hernández-Alfaro
1   Institute of Maxillofacial Surgery, Teknon Medical Centre Barcelona, Barcelona, Spanien
2   Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spanien
,
R. Guijarro-Martínez
1   Institute of Maxillofacial Surgery, Teknon Medical Centre Barcelona, Barcelona, Spanien
2   Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spanien
› Author Affiliations
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Publication History

Publication Date:
03 July 2015 (online)

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Zusammenfassung

Die Entwicklung neuer kieferorthopädischer Techniken und minimalinvasiver chirurgischer Verfahren hat in Verbindung mit modernen Typen von Patienten dazu geführt, dass neue Verfahren zur Bestimmung des passenden Zeitpunktes für die chirurgische Korrektur bei der Behandlung von dento-maxillofazialen Störungen entwickelt werden. Ziel der vorliegenden Studie war es, die Bestimmung des passenden Zeitpunktes zu definieren, zu begründen und zu systematisieren. Zu diesem Zweck wurde eine retrospektive Analyse von chirurgischen Eingriffen über einen Zeitraum von 3 Jahren durchgeführt. Insgesamt wurden 6 Behandlungsschemata definiert: „Surgery first“, „Surgery early“, „Surgery late“, „Surgery last“, „Surgery only“ und „Surgery never“. Dazu wurden die Angaben in Patientenakten zum Geschlecht, zum Alter, zur hauptsächlichen Motivation für die Behandlung, zur Dauer der kieferorthopädischen Behandlung und zur Anzahl der kieferorthopädischen Behandlungssitzungen untersucht. Insgesamt wurden 362 Behandlungen ausgewertet. Das häufigste Verfahren war dabei das „Surgery-late“-Protokoll. Während bei „Surgery-first“-, „Surgery-early“- und „Surgery-last“-Fällen die ästhetische Verbesserung als Motivation für die Behandlung an erster Stelle stand, war es bei „Surgery-late“-Fällen die Optimierung der Okklusion. Schlafapnoe stellte die Hauptindikation für „Surgery only“ dar. Im Vergleich zu „Surgery late“ war die Dauer der kieferorthopädischen Behandlung bei „Surgery-early“- und „Surgery-first“-Fällen deutlich kürzer, die Anzahl der Behandlungssitzungen jedoch vergleichbar hoch. Eine Behandlung von dento-maxillofazialen Störungen erfordert die umfassende Analyse von speziellen Variablen des Patienten, des Kieferorthopäden und des Chirurgen. Jedes der Protokolle hat seine Indikation, seine Auswirkungen auf die Behandlungsplanung und seine kieferorthopädischen und chirurgischen Besonderheiten.

Abstract

Together with the introduction of new orthodontic techniques and minimally invasive surgery protocols, the emergence of modern patient prototypes has given way to novel timing schemes for the handling of dento-maxillofacial deformities. The aim of this study was to define, justify, and systematize the appropriate timing for orthognathic surgery. A retrospective analysis of orthognathic surgery procedures carried out over a 3-year period was performed. 6 timing schemes were defined: ‘surgery first’, ‘surgery early’, ‘surgery late’, ‘surgery last’, ‘surgery only’, and ‘surgery never’. Gender, age at surgery, main motivation for treatment, orthodontic treatment length, and number of orthodontic appointments were evaluated. A total of 362 orthognathic procedures were evaluated. The most common approach was ‘surgery late’. While aesthetic improvement was the leading treatment motivation in ‘surgery first’, ‘surgery early’, and ‘surgery last’ cases, occlusal optimization was the chief aim of ‘surgery late’. Sleep-disordered breathing was the main indication for treatment in ‘surgery only’. Compared to ‘surgery late’, orthodontic treatment was substantially shorter in ‘surgery early’ and ‘surgery first’ cases, but the number of orthodontic appointments was similar. In conclusion, the skilful management of dento-maxillofacial deformities requires a comprehensive analysis of patient-, orthodontist-, and surgeon-specific variables. Each timing approach has well-defined indications, treatment planning considerations, and orthodontic and surgical peculiarities.

Schlüsselwörter

Dysgnathie-Chirurgie - Timing - Surgery-First-Verfahren - dentofaziale Anomalien - Malokklusion

Key words

orthognathic surgery - timing - surgery first - dentofacial anomalies - malocclusion

* Dieser Artikel ist im englischsprachigen Original erschienen in: Int J Oral Maxillofac Surg 2014; 43: 846–855. Der Abdruck erfolgt mit freundlicher Genehmigung.


 

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