經由雙顎正顎手術治療上顎狹窄與下顎前突合併嚴重擁擠之齒顎矯正治療－－病例報告

Orthodontic Treatment for Constricted Maxilla and Prognathic Mandible with Severe Crowding via 2- Jaw Orthognathic Surgery — A Case Report

上顎寬度不足會提升矯正治療的困難度，本篇提出一個病例，具有上顎狹窄、中臉部凹陷、下顎前突、齒瘤、合併齒列嚴重擁擠等特徵，經由上顎勒福一型三片截骨術及下顎雙側矢向骨切開術改正，在上顎寬度的改正與維持有良好成果，並使用TIOPS軟體進行治療計劃模擬與治療成果側顱描繪疊合分析。

This is a case of a 26 year-old female who complained of mandibular prognathism and malocclusion. Extraoral view revealed a concave profile with midface deficiency, mandibular prognathism, and chin deviation to right side by 4 mm. Class III malocclusion along with bilateral posterior crossbite and severe crowding were noted. Panoramic X-ray showed #83 retained, and #43 deeply impacted approximating to the mandibular lower border with a mass of radiopacity over it. Orthodontic treatment combined with a 2-jaw orthognathic surgery in which removal of #43 deep impaction was suggested. Before full mouth bonding, we referred the patient to remove #83 and the radiopaque mass to facilitate further orthodontic tooth movement. Pathology report confirmed the mass as a compound odontoma. At the preoperative orthodontic stage we performed dental decompensation. In the upper arch, two first premolars and third molars were extracted for crowding relief and alignment. In the lower arch, we created canine space in the lower right region for future prosthesis and proclining lower anteriors. Two jaw orthognathic surgery was performed including a 3-piece LeFort I segmental osteotomy for midface advancement and arch width expansion, and a bilateral sagittal split osteotomy for mandible set-back correcting chin-deviation. Removal of #43 deep impaction was also performed during the surgery. The total treatment period was 29 months and the final result was satisfying. Comparisons between virtual surgical planning by TIOPS software and the real outcome were provided.