Image-Guided Navigation in Optimizing Surgical Management of Craniomaxillofacial Fibrous Dysplasia
Image-Guided Navigation in Optimizing Surgical Management of Craniomaxillofacial Fibrous Dysplasia
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DOI：
10.1097/scs.0b013e31822e5d3d
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发表时间：
2011-09-01
影响因子：
0.9
通讯作者：
Shen, Guofang
中科院分区：
文献类型：
--
作者：
Wang, Xudong;Lin, Yanping;Shen, Guofang
背景资料：骨纤维发育不良是一种良性的骨发育异常疾病，其中异常的成纤维细胞增殖取代了正常的骨基质。颅颌面骨纤维异常增殖症可导致严重的畸形，造成破坏性的功能和美学后果。精确的手术切除纤维骨组织是最终恢复正常功能和美观的关键。导航手术工具已成为颅颌面骨骼外科治疗的一个有用的辅助手段。方法：13例颅颌面骨纤维异常增殖症所致的面部不对称畸形患者纳入本研究。通过术前计划和三维模拟，通过将健侧与患侧叠加，重建畸形区的正常解剖轮廓。结果：所有病例的面部骨骼与术前三维重建模型的配准均达到了良好的精度。在术中导航引导下，所有病例均顺利进行面骨重塑。通过比较术前和术后计算机断层扫描测量结果来评估手术准确性。实际手术复位和术前计划之间的平均最大差异小于2 mm。受影响个体中与视神经压迫相关的症状被消除。结论：导航引导下面骨塑形术是治疗颅颌面骨纤维异常增殖症的一种有价值的方法。
Background: Fibrous dysplasia is a benign developmental dysplastic disorder of the bone in which abnormal fibroblastic proliferation replaces the normal bone matrix. Craniomaxillofacial fibrous dysplasia can cause severe deformity with devastating functional and aesthetic consequence. Precise surgical removal of the fibro-osseous tissue is the key to ultimately restore normal function and aesthetics. Navigational surgical tool has become a useful adjunct in the surgical management of the craniomaxillofacial skeleton.Methods: Thirteen patients with facial asymmetry and deformity caused by craniomaxillofacial fibrous dysplasia were enrolled into this study. With preoperative planning and three-dimensional simulation, normal anatomic contours of the deformed area were recreated by superimposing unaffected to the affected side. After registration, surgical facial recontouring was performed under the guidance of navigation system.Results: Good accuracy was achieved with the registration of patient's facial skeleton and preoperative three-dimensional reconstructed model in all the cases. With intraoperative navigational guidance, facial bone recontouring was performed uneventfully in all cases. Surgical accuracy was evaluated by comparing the preoperative and postoperative computed tomography scan measurement. The mean maximum discrepancy between the actual surgical reduction and preoperative planning was less than 2 mm. Symptoms associated with optical nerve compression were eliminated in affected individuals. All patients' facial symmetry and aesthetics were improved.Conclusion: Navigation-guided facial bone recontouring is a valuable treatment modality in managing craniomaxillofacial fibrous dysplasia.