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両顎手術(BSSRO)の手術方法とダウンタイム

 

両顎手術(BSSRO)の方法
上顎と下顎両方の位置を変える手術になります。下顎のSSROと呼ばれる骨の切り方と共に上の歯から鼻の下まで切るLe Fort I と呼ばれる上顎手術を行うことを言います。12mm以上のしゃくれ顎や非対称・面長・不正咬合を改善することができます。
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輪郭手術と両顎手術の違い
勿論手術方法から見ても輪郭手術がラインを整い綺麗にする手術としたら両顎手術は上下顎全体を移動させ機能的な面の改善と口元の形も変える手術になります。良く以前働いていた病院での院長さんは輪郭手術は綺麗になるための手術であって両顎手術は機能的な面(不正咬合でうまく噛めないことから顎関節に負担がかかっているなど)を改善する手術という話をしてました。そのため、両顎手術のケースの方は機能的な面も改善したいけど綺麗になりたいという方はほとんどなので輪郭手術を共に受けることが多いです。二つは手術方法から見ると厳密に異なる手術でありますが、より完璧な結果を出すためには切り離せない手術と言えます。
両顎手術の流れ
輪郭専門医と矯正科専門とのカウンセリング

歯の型を取りそのモデルを持って手術シミュレーションを行います。waferも作成します(7日~10日かかります)

手術計画に問題がなく全身麻酔検査(血液検査と心電図検査・その他持病やアレルギー、服用している薬をチェック)に問題なければ予定通り手術を行います→平均3泊入院(呼吸がしづらくないか、炎症はないか、出血はないかを病院でチェック)

退院後は1週間毎に来院する必要があります。4週間目にWaferをはずし矯正を始めます。
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こちらは両顎手術後につける歯の固定装置Waferとよばれるものです。
4週間ほどつけておきます。矯正が始まると同時にWaferをはずします。
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両顎手術直後の様子です。Waferをつけゴムを上下の歯にかけておくため口が開けられない状態になっております。両顎手術では一旦上下顎を分離し再度固定することになるため手術直後により安全にするため上下顎が動かないように固定しておきます。これを1ヶ月間は維持するので注射器を用いて食事をします。栄養を十分とらないと両顎手術際に出血が多いのでその後貧血になることもあります。病院によっては鉄分を処方する病院もあります。食べるのがつらくとても不便ですがそれでも栄養のあるものを摂るようにすることが非常に大事となります。
ハレと経過
他の手術と同じく2~4日はものすごく腫れます。多くの患者さんが1週間までは本当つらいと言います。1週間後からはハレは早く引いて2週間経つとだいぶ良くなります。ただみなさん術後から相当痩せるので元々細い方は健康に無理が行くのではないかと心配になります。あとオレンジジュースは両顎手術後あまり良くないみたいです。私もしらなかったのですが矯正科専門医さんがお話してくれました。シッケがかなりいいみたいです。甘すぎではないかと疑問になりましたが逆に甘いものを食べるのがいいみたいです。
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こちらがシッケです。
両顎手術と鼻手術
両顎手術と鼻手術を共に行うことはできません。理由は術後より呼吸しづらくなるからです。ただ両顎手術を受けると顔がかなり小さくなるため鼻が相対的に大きく感じるようになったという方が多いです。そのことから後ほど鼻の手術を受けたいという方も多くいらっしゃいました。鼻手術は早くても両顎手術をしてから3ヶ月後に可能となります。
自分が実際に見た両顎手術
自分に両顎手術が必要かなと悩む方も多いと思います。ただ、輪郭手術も両顎手術も顔骨に関わる手術であるため正確な診断のためにはレントゲン・CT撮影・歯の型取りが必要となります。日本の整形外科で顔骨の手術前にCT撮影をしなかったという話しをたまに聞きますがこれには本当驚きました。しかも入院もしていなく当日帰されたという話しも聞くので韓国ではありえないことです。顔骨の手術後は顔の外側と内側両方腫れるのでハレが様々な器官を圧迫し呼吸しづらくなることがあります。また、炎症になると急に腫れあがるため当日もしくはそれより長く病院に入院し24時間チェックしてもらう必要があります(両顎手術は平均3~4日入院します。輪郭手術は平均1日となります)。
自分が見た両顎手術後の残念なケースとしては表情が不自然ということでした。表情がナチュラルで笑ったときも違和感なく機能的な問題(噛み合わせ)も改善することが両顎顎手術際に必要な技術と思われます。機能的な問題は改善したけど笑顔が不自然であれば完璧な手術とはいえないと思います。ただ、この全てを満足させるには非常に熟練した技術と美的センスが必要になると思います。両顎手術はとにかく危ないというイメージもありますが、これには十分考慮し計画を立てず急いで手術をさせる一部の病院の問題もあると思います。両顎手術に定評のある病院は計画を立てるのに時間をたくさんかけます。
以前早く手術を受けたいというお客さんがいたのですが私のいる病院ではそのように早く手術を進めてしまうと完璧な結果が約束できないということから断りました。結局そのお客さんは自分の時間に合わせてくれる歯医者の方で両顎手術を受けたのですが結果がよくなく、再手術のため私のいる病院に再度カウンセリングにいらっしゃいました。
自分の知っている先生は歯の型をとったモデルを用いて何度も何度もシミュレーションを繰り返します。両顎手術症例がとても豊富な専門医でもかかわらず完璧な手術を行うために適当にすることは許されないということを基本に手術計画に時間をかけます。

両顎手術(BSSRO)の手術方法とダウンタイム」への574件のフィードバック

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