Landes C A, Stübinger S, Ballon A, Sader R
Mund-, Kiefer und Plastische Gesichtschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt, Germany.
Oral Maxillofac Surg. 2008 Sep;12(3):139-47. doi: 10.1007/s10006-008-0123-7.
Piezoosteotomy was assessed as alternative osteotomy method in orthognathic surgery regarding handling, time requirement, nerve and vessel impairment.
In this comparative clinical experience, 90 patient's orthognathic surgery procedures were performed in typical distribution prospectively by piezoosteotomy: 34 (38%) monosegment, 47 (52%) segmented LeFortI osteotomies, 94 (52%) sagittal split osteotomies, 11 (12%) symphyseal, and 4 (2%) mandibular body osteotomies. As controls served 90 retrospective patients with conventional saw and chisel osteotomy: 58 (64%) monosegment, 27 (30%) segmented LeFortI osteotomies, 130 (72%) sagittal split, and 4 (4%) symphyseal osteotomies.
Piezoosteotomies were individually designed to interdigitate the jaw segments after repositioning. The pterygomaxillary suture weakened angulated tools; auxiliary chisels were required in 100% of cases for the nasal septum and lateral nasal walls, in 33% for pterygoid processes. The dorsal maxilla as the pterygoid process were easily reduced; 15% mandibular osteotomies required sawing, while the lingual dorsal osteotomy was performed by manual feedback due to limited visibility. Bloodloss decreased from average 537 +/- 208 ml vs. 772 +/- 338 ml (p = 0.0001). Operation time remained unchanged: 223 +/- 70 min vs. 238 +/- 60 min (p = 0.2) for a conventional bimaxillary procedure. Clinical courses and reossification were unobtrusive. Alveolar inferior nerve sensitivity was retained in 98% of the piezoosteotomy collective versus 84% of controls (p = 0.0001) at 3 months postoperative testing.
Piezoelectric osteotomy did not prolong the operation and reduced blood loss as alveolar nerve impairment. A few patients required additional sawing or chisel. Piezoelectric screw insertion as complex osteotomies may be initiated to simplify the procedure and increase segment interdigitation after repositioning as to minimize the osteofixation time and dimensions.
在正颌外科手术中，就操作、时间需求、神经和血管损伤方面，对压电截骨术作为一种替代截骨方法进行了评估。
在这项对比临床经验中，前瞻性地采用压电截骨术按典型分布对90例患者进行了正颌外科手术：34例（38%）单节段、47例（52%）分段LeFortI截骨术、94例（52%）矢状劈开截骨术、11例（12%）颏部截骨术以及4例（2%）下颌体截骨术。以90例采用传统锯和凿截骨术的回顾性患者作为对照：58例（64%）单节段、27例（30%）分段LeFortI截骨术、130例（72%）矢状劈开截骨术以及4例（4%）颏部截骨术。
压电截骨术经单独设计，以便在重新定位后使颌骨节段相互交错。翼上颌缝使成角工具变钝；100%的病例中，鼻中隔和鼻外侧壁截骨需要辅助凿子，33%的病例中翼突截骨需要辅助凿子。上颌骨背侧和翼突易于复位；15%的下颌截骨术需要锯切，而由于视野受限，舌背侧截骨通过手动反馈进行。出血量从平均537±208毫升降至772±338毫升（p = 0.0001）。手术时间保持不变：传统双颌手术分别为223±70分钟和238±60分钟（p = 0.2）。临床病程和再骨化过程不明显。术后3个月测试时，压电截骨术组98%的患者保留了下牙槽神经敏感性，而对照组为84%（p = 0.0001）。
压电截骨术不会延长手术时间，并减少了作为牙槽神经损伤的出血量。少数患者需要额外的锯切或凿骨操作。对于复杂截骨术可开始采用压电螺钉植入，以简化手术过程，并在重新定位后增加节段交错，从而将骨固定时间和尺寸减至最小。
