Troulis Maria J, Kaban Leonard B
Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA 02114, USA.
J Oral Maxillofac Surg. 2004 Jul;62(7):824-8. doi: 10.1016/j.joms.2003.12.021.
The benefits of minimally invasive surgery have been well documented. The purpose of this report was to present early results in a series of patients who had endoscopic mandibular orthognathic surgery. Patients and methods This is a retrospective evaluation of 14 patients who underwent endoscopic vertical ramus osteotomy and rigid fixation for the treatment of mandibular prognathism (n = 9), malocclusion secondary to trauma (n = 3), or other pathology (n = 2). A 1.5-cm incision was made directly below the mandibular angle. The dissection was continued bluntly to the masseter muscle, which was incised using a needlepoint electrocautery. Then, with endoscopic elevators, an optical cavity was created for insertion of a Hopkins endoscope and visualization of the ramus/condyle unit. Anatomic landmarks were identified and the operation carried out with specially designed endoscopic equipment. Preoperative (T0), postoperative (T1), and follow-up (T2) clinical examinations; lateral cephalograms; and panoramic radiographs were used to evaluate the outcomes.
The procedures performed included: vertical ramus osteotomy (n = 13 patients, 23 sides) and condylectomy plus vertical ramus osteotomy (n = 1 patient, 1 side). Mean operating time was 37 minutes per side. One patient had temporary marginal mandibular nerve weakness. The occlusal result was as planned in all cases. Panoramic radiographs documented postoperative ramus/condyle unit position and lateral cephalograms documented mandibular position.
The results of this case series indicate that endoscopic vertical ramus osteotomy with rigid fixation is feasible for correction of a variety of mandibular deformities.
微创手术的益处已有充分记录。本报告的目的是呈现一系列接受内镜下颌正颌手术患者的早期结果。
这是一项对14例患者的回顾性评估，这些患者接受了内镜下垂直升支截骨术及坚固内固定，以治疗下颌前突（9例）、创伤继发的错牙合畸形（3例）或其他病变（2例）。在下颌角正下方做一个1.5厘米的切口。钝性分离至咬肌，用针尖电灼器切开咬肌。然后，使用内镜剥离器创建一个光学腔，用于插入Hopkins内镜并观察升支/髁突单元。识别解剖标志，并使用专门设计的内镜设备进行手术。采用术前（T0）、术后（T1）和随访（T2）临床检查、头颅侧位片和全景X线片评估结果。
所实施的手术包括：垂直升支截骨术（13例患者，23侧）和髁突切除术加垂直升支截骨术（1例患者，1侧）。平均每侧手术时间为37分钟。1例患者出现暂时性下颌缘支神经麻痹。所有病例的咬合结果均符合计划。全景X线片记录了术后升支/髁突单元的位置，头颅侧位片记录了下颌位置。
本病例系列结果表明，内镜下垂直升支截骨术及坚固内固定对于矫正各种下颌畸形是可行的。
