Troulis M J, Nahlieli O, Castano F, Kaban L B
Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston 02114, USA.
Int J Oral Maxillofac Surg. 2000 Aug;29(4):239-42.
The endoscopic procedure for placement and activation of a distraction device for mandibular advancement has been previously reported. The purpose of this study was to demonstrate the feasibility of endoscopic exposure, dissection and osteotomy for mandibular set-back. Two cadaver and three anesthetized minipigs were used in this study. Access to the mandibular ramus was achieved through a 2.0 cm submandibular incision. The dissection was carried sharply to the mandible and completed in the subperiosteal plane. Visualization was achieved using a 2.7 mm diameter endoscope (Karl Storz, Germany). Landmarks were identified and a custom-made retractor was inserted into the sigmoid notch. A vertical ramus osteotomy was created (bilaterally) from the sigmoid notch to the mandibular angle. The mandible was set back (average 6 mm) and fixed using 2.0 mm diameter, bicortical screws. Live animals were sacrificed three weeks postoperatively. The mandibles were examined clinically and radiographically to verify proper osteotomy position and clinical union. In all animals, exposure, accurate identification of landmarks, osteotomy placement and screw fixation were achieved. In the live animals (n=3), union between the proximal and distal segments was documented by clinical and radiographic examination. This study demonstrates the feasibility of the EVRO procedure for mandibular set-back in a minipig model.
先前已有关于用于下颌前徙的牵张装置的放置和激活的内镜手术的报道。本研究的目的是证明内镜暴露、解剖和截骨用于下颌后缩的可行性。本研究使用了两具尸体和三只麻醉的小型猪。通过2.0 cm的下颌下切口进入下颌支。锐性解剖至下颌骨，并在骨膜下平面完成。使用直径2.7 mm的内窥镜（德国卡尔史托斯公司）进行可视化。识别标志点，并将定制的牵开器插入乙状切迹。从乙状切迹至下颌角（双侧）进行垂直下颌支截骨。将下颌骨后移（平均6 mm），并使用直径2.0 mm的双皮质螺钉固定。术后三周处死实验动物。对下颌骨进行临床和影像学检查，以验证截骨位置是否正确以及是否临床愈合。在所有动物中，均实现了暴露、标志点的准确识别、截骨位置的确定和螺钉固定。在实验动物（n = 3）中，通过临床和影像学检查记录了近端和远端节段之间的愈合情况。本研究证明了在小型猪模型中进行内镜下颌后缩手术（EVRO）的可行性。
