Three-Dimensional Repositioning of the Maxilla in Orthognathic Surgery Using Patient-Specific Titanium Plates: A Case Series
Three-Dimensional Repositioning of the Maxilla in Orthognathic Surgery Using Patient-Specific Titanium Plates: A Case Series
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DOI：
10.1016/j.joms.2020.11.031
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发表时间：
2021-03-29
影响因子：
1.9
通讯作者：
Afshar, Alex Ali
中科院分区：
文献类型：
--
作者：
Greenberg, Seth;Buchbinder, Daniel;Afshar, Alex Ali
目的：正颌外科手术成功的基础是术中准确执行预定的手术计划。本研究的目的是评估骨载患者专用上颌骨切割导向器和三维（3D）打印板在双颌正颌手术中重新定位上颌骨的准确性。材料和方法：这是一项回顾性病例系列，包括使用患者专用截骨导向器和3D-印刷钢板以及双侧矢状劈开截骨术，并进行6周术后锥形束计算机断层扫描研究。主要结果变量是术后上颌骨位置与在三维10个标志处测量的虚拟计划上颌骨位置之间的差异。其他研究变量包括术前诊断和每个标志的计划手术移动。结果：共10例患者纳入本研究。平均年龄为25.7 ± 8.1岁，5例女性患者。计划手术移动的中位数为x轴（左右）0.350 mm，y轴（前后）3.750 mm，z轴（上下）1.704 mm。术后位置与计划位置在x轴、y轴和z轴上的中位绝对差异分别为0.638、0.798和0.481 mm。x轴和y轴（P = 0.575）、x轴和z轴（P = 0.332）、y轴和z轴（P = 0.114）之间的差异无显著差异。结论：使用患者特定的切割导向器和3D打印板进行Le Fort I截骨术时可以根据手术计划准确地进行上颌骨的三维定位。(C)2020年美国口腔颌面外科医师协会
Purpose: Successful orthognathic surgery is fundamentally based on accurately carrying out the intended surgical plan intraoperatively. The purpose of this study was to evaluate the accuracy of boneborne patient-specific maxillary cutting guides and 3-dimensional (3D)-printed plates in repositioning the maxilla during bimaxillary orthognathic surgery.Materials and Methods: This was a retrospective case series consisting of patients who had undergone Le Fort I osteotomy with a patient-specific cutting guide and 3D-printed plate as well as a bilateral sagittal split osteotomy and had 6-week postoperative cone-beam computed tomography studies. The primary outcome variable was the difference between the position of the postoperative maxilla and the virtually planned maxilla measured at 10 landmarks in 3 dimensions. Other study variables included the preoperative diagnosis and planned surgical movement at each landmark. Descriptive statistics were tabulated, and bivariate analyses were performed.Results: A total of 10 patients were included in this study. The mean age was 25.7 +/- 8.1 years, and there were 5 female patients. The median planned surgical movement was 0.350 mm on the x-axis (right-left), 3.750 mm on the y-axis (anterior-posterior), and 1.704 mm on the z-axis (superior-inferior). The median absolute discrepancy between the postoperative position and the planned position on the x-axis, y-axis, and z-axis was 0.638, 0.798, and 0.481 mm, respectively. There was no significant difference in the discrepancies between the x-axis and y-axis (P = .575), x-axis and z-axis (P = .332), and y-axis and z-axis (P = .114).Conclusions: Using a patient-specific cutting guide and 3D-printed plate when performing Le Fort I osteotomy allows for accurate 3-dimensional positioning of the maxilla in accordance with the surgical plan. (C) 2020 American Association of Oral and Maxillofacial Surgeons