Cerrahi Destekli Hızlı Üst Çene Genişletmesi
Özet
Maksillanın yatay yöndeki gelişim yetersizliği, posterior çapraz kapanış gibi fonksiyonel ve estetik problemlere yol açan yaygın bir iskeletsel anomalidir. Bu darlığın tedavisinde kullanılan Hızlı Üst Çene Genişletmesi (HÜÇG), ortopedik kuvvetlerle midpalatal süturun açılmasını hedefler; ancak iskeletsel maturasyonunu tamamlamış yetişkin bireylerde süturların kalsifikasyonu ve artan kemik direnci nedeniyle tek başına ortopedik genişletme başarısız olmakta ve kök rezorbsiyonu, dişeti çekilmesi gibi komplikasyonlara yol açmaktadır. Bu direnci kırmak amacıyla uygulanan Cerrahi Destekli Hızlı Üst Çene Genişletmesi (CDHÜÇG), LeFort I osteotomi hatları kullanılarak apertura piriformis, zygomatik butress ve pterygoid birleşim gibi anatomik direnç alanlarının cerrahi olarak rahatlatılması esasına dayanır. Tedavide diş destekli (Hyrax) veya alveolar tippingi azaltan kemik destekli apareyler tercih edilmekte; işlem sırası ve sonrasında belirli bir aktivasyon protokolü izlenmektedir. Klinik süreç osteotomi, latent, distraksiyon, konsolidasyon ve remodelasyon safhalarından oluşurken, ideal latent dönem 5-7 gün, konsolidasyon amaçlı retansiyon süresi ise 0-12 ay arasında değişmektedir. Konvansiyonel yöntemlere kıyasla daha stabil ve aşırı düzeltme gerektirmeyen bu prosedür, düşük morbidite oranına sahip olsa da postoperatif kanama, enfeksiyon, ağrı ve sinir hasarı gibi riskler barındırdığından, 3 boyutlu görüntüleme tekniklerini içeren doğru bir teşhis ve tedavi planlaması başarının temel anahtarıdır.
Transverse maxillary deficiency is a common skeletal anomaly that causes functional and aesthetic problems such as posterior crossbite. Rapid Maxillary Expansion (RME) used in the treatment of this deficiency aims to open the midpalatal suture with orthopedic forces; however, in adults who have completed skeletal maturation, orthopedic expansion alone fails due to the calcification of sutures and increased bone resistance, leading to complications like root resorption and gingival recession. Surgically Assisted Rapid Maxillary Expansion (SARME), applied to overcome this resistance, is based on the surgical relaxation of anatomical resistance areas such as the apertura piriformis, zygomatic buttresses, and pterygoid junctions using LeFort I osteotomy lines. Tooth-borne (Hyrax) or bone-borne appliances that minimize alveolar tipping are preferred in treatment, and a specific activation protocol is followed during and after the procedure. While the clinical process consists of osteotomy, latent, distraction, consolidation, and remodeling phases, the ideal latent period varies between 5-7 days, and the retention period for consolidation ranges from 0-12 months. This procedure, which is more stable compared to conventional methods and does not require overcorrection, has a low morbidity rate but carries risks such as postoperative bleeding, infection, pain, and nerve damage; therefore, accurate diagnosis and treatment planning involving 3D imaging techniques are the essential keys to success.
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