Bettega Georges, Cinquin Philippe, Lebeau Jacques, Raphaël Bernard
Plastic and Maxillofacial Surgery Department, CHU. A. Michallon, Grenoble, Cedex, France.
J Oral Maxillofac Surg. 2002 Jan;60(1):27-34; discussion 34-5. doi: 10.1053/joms.2002.29069.
The purpose of this study was to evaluate a new method for positioning the mandibular condyle during orthognathic surgery based on 3-dimensional optical localization of infrared emitting diodes.
Eleven patients ("empirical group") underwent condylar repositioning using the empirical repositioning method (standard technique) and were considered controls. In 10 patients ("active group"), the computer-assisted system was used to replace the condyle-bearing fragment in its sagittal preoperative position. In these patients, the condylar torque was not controlled. In the third group of 10 patients ("graft group"), the computer-assisted system was used to replace the condyle in all 3 directions. Very often it was necessary in this group to fill the osteotomy gap with a bone graft. The clinical evaluation was based on 4 major criteria: the quality of the postoperative occlusion, the stability of skeletal position on successive cephalometric radiographs, the occurrence of temporomandibular dysfunction (TMD), and the preservation of mandibular motion. Clinical assessment was made at 1, 3, 6, and 12 months follow-up.
Forty-five percent of the "empirical group" did not have the expected postoperative occlusion, 5 patients showed evidence of clinical relapse at 1 year, 45% had worsened TMD status, and only 63.37% of mandibular motion had been recovered at 6 months. All the patients in the "active group" had the expected occlusion and only 1 patient exhibited a mild relapse and TMD symptoms; however the average mandibular motion recovery was only 62.65% at 6 months. All the patients in the "graft group" had a good occlusion and no relapse or TMD. Their percentage of mandibular motion recovery was 77.58%.
The quality of sagittal repositioning is the main factor contributing to a good occlusion and bone stability. Functional results (in particular, recovery of mandibular motion) are more related to limiting condylar torque.
本研究旨在评估一种基于红外发光二极管三维光学定位的正颌手术中下颌髁突定位新方法。
11例患者（“经验组”）采用经验性复位方法（标准技术）进行髁突复位，被视为对照组。10例患者（“主动组”）使用计算机辅助系统将含髁突骨块置于术前矢状位。在这些患者中，未控制髁突扭矩。第三组10例患者（“植骨组”）使用计算机辅助系统在三个方向上复位髁突。该组经常需要用骨移植填充截骨间隙。临床评估基于4个主要标准：术后咬合质量、连续头颅侧位片上骨骼位置的稳定性、颞下颌关节紊乱病（TMD）的发生情况以及下颌运动的保留情况。在术后1、3、6和12个月进行临床评估。
“经验组”中45%的患者术后咬合未达预期，5例患者在1年时出现临床复发迹象，45%的患者TMD状态恶化，6个月时仅63.37%的下颌运动得以恢复。“主动组”所有患者咬合均达预期，仅1例患者出现轻度复发和TMD症状；然而，6个月时下颌运动平均恢复率仅为62.65%。“植骨组”所有患者咬合良好，无复发或TMD。其下颌运动恢复率为77.58%。
矢状位复位质量是实现良好咬合和骨骼稳定性的主要因素。功能结果（尤其是下颌运动的恢复）与限制髁突扭矩的关系更为密切。
