Ortognatik Cerrahi Prensipleri
Özet
Ortognatik cerrahi, yüz iskeletindeki orantısızlıklar ve ciddi maloklüzyonlar nedeniyle tek başına ortodontik tedaviyle çözülemeyen vakalarda çenelerin cerrahi ve ortodonti iş birliğiyle yeniden konumlandırılması prensibine dayanır. HL Obwegeser'in bilateral sagital split osteotomi ve maksiller mobilizasyon teknikleriyle temelini attığı bu çağdaş yaklaşım; ortodontist, ağız ve çene cerrahı ile diğer uzmanların yer aldığı multidisipliner bir ekip çalışmasını zorunlu kılar. Tedavi süreci; detaylı klinik muayene, ekstraoral ve intraoral fotoğrafların çekilmesi, sefalometrik analizler ve üç boyutlu yumuşak doku değerlendirmeleriyle başlar. Geleneksel olarak artikülatörler ve alçı modeller üzerinden yürütülen cerrahi planlama, günümüzde konik ışınlı bilgisayarlı tomografi (CBCT), ağız içi tarayıcılar ve CAD-CAM yazılımları sayesinde tamamen sanal ortama taşınarak dijital iş akışına dönüşmüş; bu durum hasta konforunu artırırken splint üretim sürelerini de kısaltmıştır. Ameliyat öncesinde dekompansasyon ve diş sıralama amaçlı ortodontik hazırlık yapılırken, operasyon sonrasında ideal oklüzyonun ve uzun dönemli stabilitenin sağlanması için elastik takviyeli bitim ve retansiyon aşamaları uygulanır. Kozmetik ve fonksiyonel motivasyonlarla uygulanan bu kombine tedavi, her ne kadar hastaya yüksek memnuniyet ve olumlu estetik sonuçlar sunsa da kanama, nüks, nörolojik hasar ve enfeksiyon gibi %40'ı aşabilen çeşitli intraoperatif ve postoperatif komplikasyon risklerini barındırdığından kapsamlı bir hasta bilgilendirmesi gerektirir.
Orthognathic surgery is based on the principle of repositioning the jaws through surgical and orthodontic collaboration in cases with facial skeletal disproportions and severe malocclusions that cannot be resolved by orthodontics alone. This contemporary approach, whose foundations were laid by HL Obwegeser with bilateral sagittal split osteotomy and maxillary mobilization techniques, requires a multidisciplinary teamwork involving an orthodontist, an oral and maxillofacial surgeon, and other specialists. The treatment process begins with detailed clinical examination, extraoral and intraoral photographs, cephalometric analyses, and three-dimensional soft tissue evaluations. Surgical planning, traditionally carried out using articulators and plaster models, has now moved completely to the virtual environment via cone-beam computed tomography (CBCT), intraoral scanners, and CAD-CAM software, transforming into a digital workflow that enhances patient comfort and shortens splint production times. While presurgical orthodontic preparation is performed for decompensation and tooth alignment, postsurgical finishing and retention phases with elastic support are applied to achieve ideal occlusion and long-term stability. Although this combined treatment, performed for cosmetic and functional motivations, offers high patient satisfaction and positive aesthetic results, it carries various intraoperative and postoperative complication risks exceeding 40%, such as bleeding, relapse, neurological injury, and infection, therefore requiring comprehensive patient informed consent.
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