Osseous Transformation with Facial Feminization Surgery: Improved Anatomical Accuracy with Virtual Planning
Osseous Transformation with Facial Feminization Surgery: Improved Anatomical Accuracy with Virtual Planning
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DOI：
10.1097/prs.0000000000006166
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发表时间：
2019-11-01
影响因子：
3.6
通讯作者：
Bradley, James P.
中科院分区：
文献类型：
--
作者：
Gray, Rachel;Khang Nguyen;Bradley, James P.
背景：面部女性化手术需要一系列的外科手术，以帮助变性人通过他们确认的性别。尽管虚拟手术计划、术中切割导向器和定制钢板已被证明有助于颅颌面重建，但尚未对面部女性化手术进行研究。作者使用尸体分析进行形态分型，并证明虚拟手术计划在面部女性化手术中的实用性。方法：对50例男性尸头的额眉、侧眉、下颌角和颏部进行形态学分型。随后，将尸体分为两组：（1）虚拟手术计划术中切割导向器和（2）无术前计划。两组均接受（1）前额窦壁内移，（2）外侧眶上重塑，（3）下颌角缩小，（4）骨性颏成形术缩小。比较两组的有效率（以手术时间衡量）、安全性（根据硬脑膜或神经损伤确定）和准确性（采用三维计算机断层扫描术前计划与术后结果进行评分），显著性为p < 0.05。结果：额眉和面外侧下部以3型（重度）为主，侧眉和颏部以2型（中度）为主。对于额窦壁后退，与术前无计划相比，虚拟手术计划提高了效率（19分钟vs 44分钟; p <0.05）、安全性（100% vs 88%; p < 0.05;更少的颅内进入）和准确性（97% vs 79%; p < 0.05）。对于下颌角减小，虚拟手术计划提高了安全性（100%对88%; p < 0.05;下牙槽神经损伤较少）和准确性（95%对58%; p < 0.05）。结论：面部女性化手术的术前计划有助于确定形态分型。使用切割导向器/定制板的虚拟手术计划在执行面部女性化的四个关键颅面技术时提高了效率、安全性和准确性。
Background: Facial feminization surgery entails a series of surgical procedures that help the transwoman pass as their affirmed gender. Although virtual surgical planning, with intraoperative cutting guides, and custom plates have been shown to be helpful for craniomaxillofacial reconstruction, they have not yet been studied for facial feminization surgery. The authors used cadaveric analysis for morphologic typing and to demonstrate the utility of virtual surgical planning in facial feminization surgery procedures. Methods: Male cadaveric heads underwent morphologic typing analysis of the frontal brow, lateral brow, mandibular angle, and chin regions (n = 50). Subsequently, the cadavers were split into two groups: (1) virtual surgical planning intraoperative cutting guides and (2) no preoperative planning. Both groups underwent (1) anterior frontal sinus wall setback, (2) lateral supraorbital recontouring, (3) mandibular angle reduction, and (4) osseous genioplasty narrowing. Efficiency (measured as operative time), safety (determined by dural or nerve injury), and accuracy (scored with three-dimensional computed tomographic preoperative plan versus postoperative result) were compared between groups, with significance being p < 0.05. Results: For frontal brow and lateral lower face, morphologic type 3 (severe) predominated; for lateral brow and chin, type 2 (moderate) predominated. For frontal sinus wall setback, virtual surgical planning improved efficiency (19 minutes versus 44 minutes; p < 0.05), safety (100 percent versus 88 percent; p < 0.05; less intracranial entry), and accuracy (97 percent versus 79 percent; p < 0.05) compared with no preoperative planning. For mandibular angle reduction, virtual surgical planning improved safety (100 percent versus 88 percent; p < 0.05; less inferior alveolar nerve injury) and accuracy (95 percent versus 58 percent; p < 0.05). Conclusions: Preoperative planning for facial feminization surgery is helpful to determine morphologic typing. Virtual surgical planning with the use of cutting guides/custom plates improved efficiency, safety, and accuracy when performing four key craniofacial techniques for facial feminization.