Belli Evaristo, Matteini Claudio, D'Andrea Gian Carlo, Mazzone N
Department of Maxillo-Facial Surgery, S. Andrea Hospital, University of Rome La Sapienza, II Medicine and Surgery Faculty, Rome, Italy.
J Craniofac Surg. 2007 Nov;18(6):1410-5. doi: 10.1097/scs.0b013e3181534b26.
In recent years, surgical trends showed an interest for minimally invasive surgery. Endoscopically assisted techniques were developed and widely reported. Endoscopic approaches can sometimes represent an alternative to traditional surgery. Such approaches minimize unwanted sequelae such unaesthetic scars and iatrogenic damage of facial nerve. In the reported case, the endoscopic approach and the navigator guide allowed reshaping of mandibular ramus up to the medial condilar surface, where an osteophite was present. To solve the intraarticular, mechanical obstacle, medial surface of mandibular condyle was reshaped. Such surgery represents a valid conservative solution; for traditional surgery with transcutaneous approach, a condylectomy should have been planned. The navigator (Brain Lab, Feldkirchen, Germany) allowed the checking of anatomic landmarks, even in bone with anatomy subversion, and guided its reshaping. The technique is summarized with step-by-step explanations. Further studies are obviously required to standardize the technique, and even technical and technological advances are expected, but computer-aided endoscopic surgery could be introduced to allow surgery on temporomandibular joints.
近年来，手术趋势显示出对微创手术的青睐。内镜辅助技术得以发展并被广泛报道。内镜入路有时可替代传统手术。此类入路可将诸如不美观的瘢痕以及面神经的医源性损伤等不良后遗症降至最低。在本报道病例中，内镜入路及导航引导实现了下颌支直至内侧髁突表面（此处存在骨赘）的重塑。为解决关节内的机械性障碍，对下颌髁突的内侧表面进行了重塑。此类手术是一种有效的保守解决方案；对于经皮入路的传统手术，本应计划行髁突切除术。导航仪（德国费尔德kirchen的Brain Lab公司）即便在解剖结构被破坏的骨质中也能对解剖标志进行核查，并引导其重塑。现将该技术以分步解释的方式进行总结。显然需要进一步研究以规范该技术，而且即便期待技术和工艺取得进展，但计算机辅助内镜手术可被引入以实现颞下颌关节手术。
