Vorbereitung auf eine kieferorthopädisch-chirurgische Korrektur - Veränderung der oberen Zahnbogenbreite

Zusammenfassung

Bei Patienten, die für eine kieferorthopädisch-chirurgische Korrektur vorgesehen sind, scheint eine zu schmale Maxilla ein besonderes häufiges Problem zu sein. Es ist oft schwierig, präoperativ die erforderliche Breite mit kieferorthopädischen Mitteln herbeizuführen, ohne die Zähne zu stark zu kippen oder die Zahnwurzeln durch die bukkale Wand des Alveolarfortsatzes nach außen zu bewegen. Eine Segmentosteotomie in der Le-Fort-I-Ebene ist zwar möglich, jedoch gewinnt man dadurch nur etwa 5 mm an Breite und die Komplikationsrate ist relativ hoch. Eine präoperative kieferchirurgisch unterstützte Gaumennahterweiterung kann dagegen ambulant durchgeführt werden. Unter Berücksichtigung der Prinzipien der Distraktionsosteogenese lässt sich auf diese Weise eine deutliche und stabile Weitung des Oberkiefers durchführen. Der vorliegende Beitrag stellt Indikationen, Techniken und Ergebnisse dieses Verfahrens vor.

Abstract

Lack of maxillary width appears to be a considerable problem in preoperative orthodontic preparation of patients for orthognathic surgery. It is frequently difficult to obtain the necessary maxillary width orthodontically preoperatively without tipping the teeth abnormally or pushing the buccal roots of the teeth out through the buccal plate of bone of the maxilla. Although multi-piece segmental Le Fort I level osteotomies are possible, even if they can only gain approximately 5 mm of additional maxillary width, and there is a morbidity associated with this procedure. A preliminary surgically assisted rapid palatal expansion can be carried out as an outpatient procedure and, applying the principals of distraction osteogenesis, a considerable and stable increase in maxillary width can be obtained. This article will discuss the indications, techniques and results of such procedures.

Schlüsselwörter

KFO-Chirurgie - Distraktionsosteogenese

Key words

orthodontic surgery - distraction osteogenesis

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