手術矯正治療臉部不對稱骨性第一級咬合異常之病例報告

Surgical-Orthodontic Correction of Skeletal Class I Malocclusion with Facial Asymmetry: A Case Report

隨著矯正患者對於顏面美觀的重視，臉部不對稱常是患者求診的主要訴求。臉部不對稱大致可區分為三類：下顎骨偏移、純粹齒源性不對稱、及骨性不對稱，下顎骨過度發育可能造成咬合關係不對稱及下顎骨偏移，臨床上常見咬合面傾斜及顏面不對稱的表現，這類患者經常需要進行雙顎正顎手術及齒列矯正才能改善嚴重的異常咬合問題，當患者的臉部不對稱同時合併有軟組織及硬組織的問題，也會大幅增加治療困難度。本文提出一位二十九歲男性，經診斷為骨性第一級異常暨安格氏第三級咬合關係合併臉部不對稱、咬合平面向左側傾斜及下巴向右偏移。經過初期齒列整平及排列，並使用骨性錨定改善咬合平面傾斜後，透過下顎正顎手術改正下顎骨偏移的問題，整體治療的時間為一年十個月，治療後臉部不對稱有相當明顯改善，上下齒列異常咬合關係也獲得良好穩定的治療結果。

Correction of facial asymmetry is one of the most difficult challenges in orthognathic surgery. Bardinet1 classified facial asymmetries based on three clinical entities: mandibular lateral deviations, dental asymmetries without skeletal involvement, and skeletal asymmetries. In some cases, combinations of soft tissue deformities and skeletal discrepancies complicate treatment outcome and management. This report presents a case of a 29-year-old male with skeletal Class I malocclusion, high mandibular plane angle, facial asymmetry, and dental Class III malocclusion. Mild left-side down occlusal plane canting and chin deviation to right side was observed. The pre-surgical orthodontic treatment started with full-mouth fixed appliance therapy for teeth leveling, alignment, and dental decompensation in both the sagittal and transverse aspects. The canted occlusal plane was corrected by using temporary anchorage devices for intrusion of upper left posterior teeth. Then mandibular surgery with bilateral sagittal split osteotomy was performed. The total treatment time was 20 months. With the aid of TADs to correct the occlusal plane canting, the treatment approach of orthognathic surgery could be simplified to one jaw surgery in patients with vertical maxillary asymmetry.