淺談齒顎矯正手術與照護

Introduction of Orthognathic Surgery and Nursing Care

愛美是人的天性，擁有一副姣好的面貌是每個人的期望，但先天的顏顎面畸形與後天外傷造成的顏面構造改變在人群中仍佔有相當的比例。一般牙齒排列不整在適當的矯正治療下可獲得改善，但嚴重骨骼異常者則需借助所謂的正顎手術治療(即齒顎矯正手術)，因顱顏骨骼在7-15歲生長發育的趨勢幾乎可以決定成年後的形態，因此手術多集中在16~18歲年齡層之病人。咬合不良之分類是依據EdwardAngle(1959)所提出的以上顎第一大臼齒為咬合之鍵將不正咬合分為三大類即安格式第一類、第二類與第三類咬合異常。不同人種其咬合異常盛行率亦不同，本篇文章主要針對顏顎面畸形需進行手術之狀況做介紹，手術種類包括：下顎骨體區骨切開術、下顎前部根尖下骨切開術、雙側矢向分裂骨切開術、上顎前部骨切開術、全上顎手術(勒福式一型)、頦成形術。術後照護重點包括：維持呼吸道通暢、預防出血發生、預防感染、注意營養之補充、加強口腔衛生、注意雙向溝通等。齒顎矯正手術在術前須做精細的評估，讓病人對術後的模樣有基本的概念，由於術後外觀變化極大，且術後的不適會讓病人感到沮喪，因此，除需做好自我調適外，家人也應在旁給予精神上的支持，唯有團隊合作才能使矯正手術順利完成，給予病人一個全新、自信的面貌。

Congenital maxilla facial deformity and traumatism cause the jaw asymmetries and deformitiesamong crowd for most proportions. Facial and occlusal abnormality is severe enough but may beimproved by orthognathic surgery. The operation concentrate on 16-18-year old patients. Accordingto Edward HartleyAngle (1959) malocclusions can be divided mainly into three types：Angle'sclass I, Angle's class II and Angle's class III. This article describes the treatment of malocclusionsby orthognathic surgery, and the operation includes: Mandibular anterior osteotomy, Mandibularanterior subapical osteotomy,Bilateral Saggital SplitOsteotomy(BSSO),Maxillary anterior osteotomy,Le Fort I osteotomy and Genioplasty. After-operation nursing care includes：keeping the airwayunobstructed, preventing bleeding, preventing infection, nutrition supplements, good oral hygiene,paying attention to the communication, etc. The appearance changes a lot big after the operation,and it is uncomfortable. The patient may feel depressed, so preparing his mind and family's mentalsupport are important.