Commentary on: Three-Dimensional Custom-Made Surgical Guides in Facial Feminization Surgery: A Prospective Study on Safety and Accuracy.
Commentary on: Three-Dimensional Custom-Made Surgical Guides in Facial Feminization Surgery: A Prospective Study on Safety and Accuracy.
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评论：面部女性化手术中的三维定制手术指南：安全性和准确性的前瞻性研究。
DOI：
10.1093/asj/sjaa422
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发表时间：
2021
影响因子：
2.9
通讯作者：
D. Coon
中科院分区：
文献类型：
--
作者：
Matthew Louis;Stephanie Preston;D. Coon
本文介绍了虚拟手术计划（VSP）的临床数据，以及在面部女性化手术（FFS）中使用切割导向器，包括额窦后退、下颌角复位和骨性颏成形术。作者试图通过描述其并发症发生率并比较术前模拟和术后结果来建立该技术的安全性和某种程度上的有效性。据推测，标题所指的临床FFS方案是“前瞻性的”，而不是实际的研究本身，因为由于缺乏预先计划的计算机断层扫描（CT）扫描，只有不到60%的患者可以评估主要终点的准确性，并且没有预先规定的准确性指标、结果工具或纳入标准，也没有提及前瞻性机构审查委员会批准的研究方案的入组。值得祝贺的是，作者在不断发展的FFS领域解决了文献中的缺陷。他们报告了总体2.2%的并发症发生率，归因于1次术后感染需要再次干预，脑脊液漏和神经损伤的发生率为0%。VSP可能降低下颌角切除术的发病率：另一组研究描述了使用切割导具显著减少下牙槽神经损伤。2然而，尽管FFS手术并发症的报道不一致，但从现有文献来看，前额女性化手术的总并发症发生率已经很低，为1.3%。这突出了复杂性作为FFS终点的局限性：创新的主要驱动力是对更具可预测性的美学结果的渴望。VSP越来越多地应用于颅面外科和美容外科的各个领域，特别是在正颌手术中。VSP的准确性评估是一个具有挑战性的问题。在计算机辅助手术文献中，有几种一致的、经过验证的方法可以做到这一点，包括确定类内相关系数或相对于固定骨标记的线性和角距离。5本研究的作者使用全局配准，并将精度定义为落在术前模拟1mm位移范围内的点的百分比。然而，它们不包括对测量精度至关重要的其他因素，包括配准误差(即
This article presents clinical data on virtual surgical planning (VSP) and the use of cutting guides in facial feminization surgery (FFS), including frontal sinus setback, mandibular angle reduction, and osseous genioplasty. The authors seek to establish the safety, and to some degree the efficacy, of this technique by describing their complication rates and comparing preoperative simulation with postoperative results. It is presumed that the title references that the clinical FFS protocol was “prospective” rather than the actual research study itself, insofar as the primary endpoint of accuracy could be assessed in fewer than 60% of patients due to the lack of preplanned computed tomography (CT) scans and there were no prespecified accuracy metrics, outcome instruments, or criteria for inclusion, or any mention of enrollment in a prospective institutional review board–approved research protocol. The authors are to be congratulated for addressing a deficit in the literature in the growing field of FFS. 1 They report an overall 2.2% complication rate, attributed to 1 postoperative infection requiring reintervention, and a 0% incidence of cerebrospinal fluid leaks and nerve injuries. VSP may decrease morbidity in mandibular angle resection: another group has described a significant reduction in inferior alveolar nerve injury with the use of cutting guides. 2 However, although the reporting of complications in FFS is inconsistent, the pooled complication rate from available literature in forehead feminization surgery is already very low at 1.3%. 3 This highlights the limitations of complications as an endpoint for FFS: the primary driver of innovation is the desire for more aesthetic results with greater predictability.VSP is increasingly applied to various fields within craniofacial and aesthetic surgery, particularly in orthognathic surgery. 4 Assessment of accuracy in VSP is a challenging problem. There are several consistent, validated methods in the computer-aided surgery literature for doing this, including the determination of the intraclass correlation coefficient or linear and angular distances relative to fixed bony landmarks. 5 The authors of this study use global registration and define accuracy as the percentage of points falling within 1 mm displacement of the preoperative simulation. However, they do not include other factors essential to measuring accuracy including registration error (ie,