Computer-Assisted Design of Sequential Surgical Procedure for Oblique Facial Clefts With Mandibular Outer Cortex Autografts
Computer-Assisted Design of Sequential Surgical Procedure for Oblique Facial Clefts With Mandibular Outer Cortex Autografts
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DOI：
10.1097/scs.0000000000001048
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发表时间：
2015-03
期刊：
影响因子：
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通讯作者：
Tian Jin;Jian-feng Liu;L. Gui;F. Niu;Bing Yu
中科院分区：
文献类型：
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作者：
Tian Jin;Jian-feng Liu;L. Gui;F. Niu;Bing Yu
面斜裂是一种影响面部结构正中线的先天性颅面畸形。这些缺损的矫正涉及骨和软组织重建。作者开发了一种计算机辅助的面部斜裂连续手术程序，包括下颌骨外皮质自体移植、内眦韧带复位和固定以及脂肪自体移植。方法自2004年至2013年，对12例面斜裂患者（女性9例，男性3例）采用三步手术治疗。首次手术时患者的平均年龄为18岁（范围：13-25岁）。术前三维手术模拟辅助手术。对患者的临床、影像学和放射学记录进行回顾性分析。结果所有患者治疗效果显著，满意度高。术后患者畸形严重程度10分制自评评分较低（P < 0.001），6 ~ 12个月后保持稳定（P = 0.069）。内眦复位良好（P < 0.001），无明显复发（P = 0.096）。下颌骨供区的平均（SD）恢复率为48.44%（16.89%）（范围，11.03%-71.33%）。移植骨吸收在不同受体部位无显著差异。仅6例患者发生轻微并发症。结论该术式是一种治疗面斜裂的有效方法，患者满意度高，面部对称性明显改善，皮肤瘢痕少，植骨吸收可接受，下颌骨供区恢复显著。计算机辅助手术模拟能有效地描述特征性骨骼畸形，并为外科重建提供有用的指导。
BackgroundOblique facial clefts are congenital craniofacial malformations affecting the paramedian line of facial structures. Correction of these defects involves bone and soft tissue reconstruction. The authors have developed a computer-aided sequential surgical procedure for oblique facial clefts, including mandibular outer cortex autografting, medial canthal ligament reduction and fixation, and fat autografting. MethodsFrom 2004 to 2013, 12 patients (9 women, 3 men) with oblique facial clefts were treated with the 3-step procedure in our clinic. Mean patient age at the first surgery was 18 years (range, 13–25 years). Preoperative three-dimensional surgical simulations assisted the surgeries. A retrospective review of patients’ clinical, photographic, and radiographic records was performed. ResultsAll patients achieved significant treatment effects and high satisfaction. The patients’ self-assessed scores on a 10-point scale of deformity severity were lower after surgery (P < 0.001) and remained stable after 6 to 12 months (P = 0.069). Good repositioning of the inner canthus was achieved (P < 0.001) with no significant relapse (P = 0.096). The mean (SD) recovery of mandibular donor sites was 48.44% (16.89%) (range, 11.03%–71.33%). Grafted bone absorption was not significantly different at different recipient sites. Only minor complications occurred in 6 patients. ConclusionsThis procedure was an effective treatment for oblique facial clefts, resulting in high satisfaction, remarkable improvements in facial symmetry, little skin scarring, acceptable bone graft resorption, and dramatic recovery of mandibular donor sites. Computer-assisted surgical simulation effectively describes characteristic skeletal deformities and provides a useful guide to surgical reconstruction.