Maercks Rian Adam, Taylor Jesse A, Gordon Christopher B
Department of Plastic Reconstructive and Hand Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.
J Craniofac Surg. 2010 Mar;21(2):479-82. doi: 10.1097/SCS.0b013e3181cfeca4.
The monobloc procedure has been criticized owing to its tendency for cerebrospinal fluid leak, relapse, infection, and incomplete ossification. Such risks have been decreased through gradual advancement of the monobloc via distraction osteogenesis. This cadaver study was undertaken to develop an endoscopic, ultrasonic monobloc osteotomy to further minimize risks and potentially improve outcomes.
Three fresh, adult human cadavers were used in this study. Endoscopic ultrasonic monobloc osteotomy was completed in all cadavers with 3 incisions hidden in the hair-bearing scalp. The incisions afforded access for small craniotomies through which the dura was dissected from the frontal bones. An ultrasonic scalpel and endoscope then traveled extradurally to osteotomize the frontal bones, temporal bones, sphenoid wings, and superior aspects of the orbits intracranially. Pterygomaxillary dysjunction was performed with conventional osteotomes intraorally.
The endoscopic ultrasonic monobloc osteotomy was completed as a single fragment in all 3 cadavers. No additional incisions were required. Completeness of the osteotomy and integrity of the single fragment were evaluated by manual examination and endoscopic visualization of free movement at osteotomy sites. Osteotomy completion took less than 2.5 hours. Dura and periosteum surrounding all osteotomies remained intact, eliminating concern for injury to adjacent soft tissue. Careful placement of temporal incisions and craniotomies was critical to facilitate completion of osteotomies in a clinically safe manner.
We have demonstrated the feasibility of an endoscopic ultrasonic monobloc advancement technique in cadavers. The technique can be completed without a bicoronal incision while completely protecting all vital structures. The preservation of vascularity and periosteum afforded by this technique may provide improved outcomes and reduced complications.
整块切除术因有发生脑脊液漏、复发、感染及骨化不全的倾向而受到批评。通过牵张成骨逐渐推进整块切除术，此类风险已有所降低。本尸体研究旨在开发一种内镜下超声整块截骨术，以进一步降低风险并可能改善治疗效果。
本研究使用了三具新鲜的成年人体尸体。所有尸体均通过隐藏在有毛发头皮中的3个切口完成内镜下超声整块截骨术。这些切口为小骨窗开颅提供了入路，通过该入路从额骨分离硬脑膜。然后，超声刀和内镜在硬膜外行进，在颅内对额骨、颞骨、蝶骨翼和眶上缘进行截骨。经口用传统骨凿进行翼上颌离断术。
所有3具尸体均以单个骨块完成内镜下超声整块截骨术，无需额外切口。通过手动检查和内镜观察截骨部位的自由移动情况，评估截骨的完整性和单个骨块的完整性。截骨完成时间不到2.5小时。所有截骨周围的硬脑膜和骨膜均保持完整，消除了对相邻软组织损伤的担忧。仔细放置颞部切口和开颅部位对于以临床安全的方式完成截骨至关重要。
我们已在尸体中证明了内镜下超声整块推进技术的可行性。该技术无需双冠状切口即可完成，同时能完全保护所有重要结构。该技术保留血管和骨膜，可能会改善治疗效果并减少并发症。
