Critical evaluation of piezoelectric osteotomy in orthognathic surgery:: Operative technique, blood loss, time requirement, nerve and vessel integrity
Critical evaluation of piezoelectric osteotomy in orthognathic surgery:: Operative technique, blood loss, time requirement, nerve and vessel integrity
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DOI：
10.1016/j.joms.2007.06.633
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发表时间：
2008-04-01
影响因子：
1.9
通讯作者：
Sader, Robert
中科院分区：
文献类型：
--
作者：
Landes, Constantin A.;Stuebinger, Stefan;Sader, Robert
目的：从手术技术、出血量、时间要求、神经血管完整性等方面评价压电截骨术在正颌手术中替代传统锯的可行性。患者和方法：50例患者采用典型分布的正颌骨手术：单节段22例（44%），节段Le Fort I截骨26例（52%）；矢状面劈开截骨48例（48%），联合截骨6例（12%），下颌骨体截骨4例（4%）。对照组86例采用常规锯凿截骨术：57例（66%）采用单节段截骨术，25例（29%）采用节段Le Fort I截骨术，126例（73%）采用矢状面截骨术，4例（5%）采用联合截骨术。结果：压电骨截骨术允许个性化切割设计，使复位后的节段交叉。成角的工具削弱了翼颌缝合；鼻中隔100%的病例需要辅助凿子，翼状突46%的病例需要辅助凿子。下骨折后，上颌窦背壁和翼状突容易复位。成功避免了出血，平均失血量为541 +/- 150 mL，而传统的双腋窝手术平均失血量为773 +/- 344 mL， （P = 0.001）。矢状下颌截骨需要相当长的时间（13%为辅助锯）；舌背截骨多采用触觉方式。时间投入保持不变：双颌标准截骨227 +/- 73分钟vs 238 +/- 61分钟（P = 0.5）；临床病程和骨化情况不明显。术后3个月检测时，95%的研究群体保留了肺泡下神经敏感性，而对照组为85% （P = 0.0003）。结论：压电截骨术减少了失血量和下牙槽神经损伤，无需额外的时间投入。单箱需要辅助凿或锯。可以开发用于螺钉插入和复杂截骨设计的压电钻孔，以在复位后保持骨接触或指间连，并最大限度地减少固定骨的需要。(C) 2008年美国口腔颌面外科医师协会。
Purpose: Piezo-osteotomy feasibility as a substitute for the conventional saw in orthognathic surgery was evaluated regarding operative technique, blood loss, time requirement, and nerve and vessel integrity.Patients and Methods: Fifty patients had orthognathic surgery procedures in typical distribution using piezosurgical osteotomy: 22 (44%) monosegment, 26 (52%) segmented Le Fort I osteotomies; 48 (48%) sagittal split osteotomies, 6 (12%) symphyseal, and 4 (4%) mandibular body osteotomies. Controls were 86 patients with conventional saw and chisel osteotomies: 57 (66%) monosegment, 25 (29%) segmented Le Fort I osteotomies, 126 (73%) sagittal split, and 4 (5%) symphyseal osteotomies.Results: Piezosurgical bone osteotomy permitted individualized cut designs, enabling segment interdigitation after repositioning. Angulated tools weakened the pterygomaxillary suture; auxiliary chisels were required in 100% of cases for the nasal septum, and lateral nasal walls as 46% pterygoid processes. After downfracture, the dorsal maxillary sinus wall and pterygoid processes were easily reduced. Hemorrhage was successfully avoided with average blood loss of 541 +/- 150 mL versus 773 +/- 344 ml, (P = .001) for a conventional bimaxillary procedure. Sagittal mandibular osteotomy required considerable time (auxiliary saw in 13%); the lingual dorsal osteotomy was mostly performed tactile. Time investment remained unchanged: 227 +/- 73 minutes per bimaxillary standard osteotomy versus 238 +/- 61 minutes (P = .5); clinical courses and reossification were unobtrusive. Alveolar inferior nerve sensitivity was retained in 95% of the study collective versus 85% in the controls (P = .0003) at 3 months postoperative testing.Conclusions: Piezoelectric osteotomy reduced blood loss and inferior alveolar nerve injury at no extra time investment. Single cases require auxiliary chiseling or sawing. Piezoelectric drilling for screw insertion and complex osteotomy designs may be developed to maintain bone contact or interdigitation after repositioning and minimize need for osteofixation. (C) 2008 American Association of Oral and Maxillofacial Surgeons.