Le Fort I 骨切り術による III 級顎顔面変形症の矯正における Surgery-First Approach は有利か？

Surgery-first approach for correction of class III dentofacial deformity with Le Fort I osteotomy; is it advantageous?

抄録

顎矯正治療におけるSFA（Surgery-First Approach）は、治療効果を損なわずに治療期間を短縮することを目的としている。しかし、達成された咬合を客観的に評価する方法は限られている。本研究では、SFAとOFAの2つの患者群について、治療期間、外来受診回数、および咬合成績の質を評価することを目的とした。Le Fort I上顎骨切り術のみを行ったIII級不正咬合症例について，連続20例のSFAと連続23例のOFAの症例記録をもとにレトロスペクティブ・コホートスタディを実施した．治療前と治療後のスタディモデルをPeer Assessment Rating（PAR）を用いて評価した。有効治療期間（中央値）（SFA：10.2ヶ月、OFA：32.5ヶ月）と予約数（SFA：14回、OFA：24回）に有意差（p<0.001）を認めた。PARの絶対値減少の中央値は、SFAで40、OFAで39であった。咬合矯正の質に関しては、両群間に有意差はなかった。SFA群の治療期間はOFA群に比べ有意に短く，外来受診回数も少なかった．SFA群とOFA群の咬合成績の質は，両群とも満足できるものであり，同等であった．

The surgery-first approach (SFA) to orthognathic treatment aims to reduce its duration without compromising the outcome. However, the objective assessment of the achieved occlusion has been limited. This study was designed to assess the treatment duration, outpatient appointment number, and quality of occlusal outcomes for two groups of patients; one treated with the SFA and the other with an orthodontics-first approach (OFA). We carried our a retrospective cohort study of case records for twenty consecutive SFA, and 23 consecutive OFA, cases with class III malocclusions, treated with Le Fort I maxillary osteotomy only. Pre-and post-treatment study models were assessed using the Peer Assessment Rating (PAR). Significant differences (p<0.001) were found between the median active treatment durations (10.2 months for the SFA and 32.5 months for the OFA) and appointment numbers (14 for SFA and 24 for OFA). Median absolute PAR reductions were 40 for the SFA and 39 for the OFA. There was no significant difference between the groups regarding quality of occlusal correction. Treatment durations for the SFA group were significantly shorter than for the OFA group, with fewer outpatient appointments. The quality of occlusal outcome for both SFA and OFA groups were satisfactory and comparable.