Alt Çenede Uygulanan Ortognatik Cerrahi Teknikleri
Özet
Ortognatik cerrahi, maksillofasial kompleksi doğru iskeletsel yapıya getirerek hastaların fonksiyonel, okluzal ve estetik gereksinimlerini karşılamayı amaçlayan bütüncül bir yaklaşımdır. Hayat kalitesini ve öz güveni artıran bu operasyonların; his kaybı, enfeksiyon, istenmeyen kırıklar ve hava yolu değişiklikleri gibi riskleri bulunur. Alt çene anomalilerinin tedavisinde sıklıkla Bilateral Sagittal Split Osteotomisi (BSSO) tercih edilir; çünkü ramusun ayrılmasıyla proksimal ve distal fragmanlar elde edilerek hemen her iskeletsel bozukluğa uygulanabilir. Vertikal Ramus Osteotomisi ise daha sınırlı kullanım alanına sahip olup, genellikle alt çeneyi geri alma vakalarında masseter kası korunarak intraoral yolla uygulanır. Çene ucunu üç boyutlu hareket ettiren Genioplasti operasyonunda ise mental sinirin ve kasların korunması pitozisi önlemek adına kritiktir. Ayrıca segmental cerrahiler ile Alveolaris inferior sinir hasarını önlemeyi amaçlayan Ters L osteotomisi gibi alternatif yöntemler de mevcuttur. Bimaksiller vakalarda stabil fiksasyon avantajıyla "önce mandibula" tekniği uygulanabilirken; eklem rahatsızlıklarından kaynaklanan ağır deformitelerde bilgisayar destekli cerrahi simülasyon (CASS) ile kişiye özel eklem protezi ve ortognatik cerrahi kombine edilerek başarılı fonksiyonel sonuçlar elde edilir.
Orthognathic surgery is a holistic approach aimed at bringing the maxillofacial complex into the correct skeletal structure to meet the functional, occlusal, and aesthetic requirements of patients. While improving quality of life and self-confidence, these operations carry risks such as loss of sensation, infection, unfavorable fractures, and airway alterations. Bilateral Sagittal Split Osteotomy (BSSO) is frequently preferred for treating mandibular anomalies because it can be applied to almost all skeletal deformities by splitting the ramus into proximal and distal fragments. Vertical Ramus Osteotomy has a more limited application and is generally performed intraorally for mandibular setback cases while preserving the masseter muscle. In Genioplasty, which moves the chin tip three-dimensionally, protecting the mental nerve and muscles is critical to preventing ptosis. Additionally, segmental surgeries and alternative methods like the inverted-L osteotomy exist to prevent inferior alveolar nerve damage. In bimaxillary cases, the "mandible first" sequence can be utilized due to stable fixation advantages, whereas in severe deformities caused by joint disorders, computer-aided surgical simulation (CASS) is combined with patient-specific joint prostheses and orthognathic surgery to achieve successful functional results.
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