DO arch expansion with too narrow maxillary dental arch

The DO arch expansion with a maxillary arch is used for prolongation of the craniofacial bone traction. Treating diseases: maxillary retraction Indication The general condition is the same as that of orthognathic surgery and implant surgery. The main diseases currently available for treatment with DO are: 1. (Upper, lower) stenosis of the dental arch - crowded dentition (pre-orthodontic treatment without extraction). 2. Small jaw deformity (with sleep apnea syndrome). 3. The second sacral arch syndrome, hemifacial hypoplasia or hemifacial atrophy. 4. Partial malformation. 5. Inferior facial development caused by maxillary retraction deformity and cleft palate. 6. The distance between the jaws is too low. 7. The alveolar ridge is too low or defective. 8. Old fractures are healed. 9. The bones are not connected. 10. Jaw defects. 11. Congenital craniofacial deformities, such as Crouzen, Robin, Treacher-Collins and other syndromes. 12. Skull defects. The age of the patient's surgery is generally considered to begin DO surgery after 4 years of age. In addition to considering the regenerative capacity of the patient's bone and soft tissue, they also need to take into account their ability to cooperate. Contraindications Basically the contraindications for surgery in orthognathic surgery, as well as: 1. Jaw osteomyelitis. 2. Severe jaw osteoporosis. 3. Blood system diseases. Preoperative preparation The surgeon must have basic knowledge and skills in orthognathic surgery, orthopedics, strong internal fixation of the jaw, and orthodontics. 1. Photographic standard positive lateral position, dentition and bite relationship. 2. X-ray film treatment plan must use complete imaging data, such as standard positive lateral cephalometric film, full-mouth curved tomogram, dome film, and if necessary, design the teeth in the osteotomy area to Get accurate tractor placement. 3. Head shadow measurement analysis and model analysis. 4. According to the paper cutting surgery and model surgery design osteotomy line, traction direction, simulate the tractor placement surgery. 5. Teeth cleaning. 6. Appropriate preoperative compensation for orthodontic treatment. 7. The assisted orthodontic treatment plan in traction, and proposes a solution to open and adjust the bite. 8. Evaluation of temporomandibular joint. 9. Oral cleansing, preparation of skin around the mouth. Craniotomy requires scalp preparation. Surgical procedure Incision A horizontal incision between the canines of the maxillary vestibular sulcus, the midline periosteum was removed downward to the intrinsic gingiva, and the lower edge of the plowed hole was exposed upward to separate the nasal mucosa. 2. Osteotomy Use a sagittal saw or a compound saw to fit the nasal septum from the side of the nasal base to the underside of the apex between the maxillary central incisors (Fig. 10.8.3.1.3-5). Under the guidance of the finger, use a thin bone knife to cut the alveolar process with the thin bone knife, and cut the maxillary condyle and the humerus horizontal plate backwards. Be careful not to wear the temporal mucosa and the nasal mucosa. 3. Placement of the tractor Oral built-in retractor for placement of bone anchorage or dentition anchorage. 4. suture the wound Intermittently suture the wound and tightly wrap around the tractor fixed wing. 5. Afterburner After 3 to 5 days after surgery, the force was started. The rate of acceleration and rhythm are the same as those of the mandible until the design is expanded. 6. Maintain The gap can be maintained with a tractor, a dental arch, a bracket archwire or a temporary denture. The duration of the maintenance period is generally shorter than that of the mandible. 7. Remove the tractor After the maintenance period, the X-ray must be bitten to determine the density of the bone density in the traction gap close to the surrounding bone to remove the tractor. 8. Continue orthodontic treatment to align the upper jaw dentition and adjust the bite relationship.