Kaduk Wolfram M H, Podmelle Fred, Louis Patrick J
Department of Maxillofacial Surgery/Plastic Surgery, Greifswald University, Greifswald, Germany.
J Oral Maxillofac Surg. 2012 Feb;70(2):421-8. doi: 10.1016/j.joms.2011.02.027.
Today, the most common orthognathic procedure for correction of mandibular deformities is the bilateral sagittal split osteotomy, also called sagittal ramus osteotomy. Permanent injury to the mandibular nerve (V3) is one of the main complications, with a reported incidence between 5% and 30%. Orthognathic surgery using sagittal ramus osteotomy of the mandible as the procedure of choice should be re-evaluated because of the complexity and the relatively high risk of damage to the inferior alveolar nerve. Surgical techniques that allow for accurate condylar positioning with a lower risk of inferior alveolar nerve injury should be considered. The aim of this study is to present a retrospective case series using the previously described horizontal osteotomy of the mandibular rami along with modern-day technical advances that make this procedure safe, reliable, and reproducible.
We performed a modified approach to the supraforaminal horizontal oblique osteotomy of the mandible with a condylar positioning device, endoscopy, and a surgical navigation system. This technique was performed in 17 consecutive patients. Postoperatively, we measured the amount of surgical movement of the mandible, monitored the mandibular nerve, and evaluated bone healing during removal of the osteosynthesis plates.
In all 17 treated patients there was uneventful wound healing, and no patient had permanent nerve alteration. The mean movement of the mandible was 7.48 mm (SD, 2.1 mm), with a range from 3.0 to 10.5 mm. The mean follow-up was 19 months. The main purpose of the surgical navigation was the translation of the planned osteotomy line from the computed tomography scan to the surgical site during the operation. This was performed to prevent a large gap between the bone segments at the osteotomy site.
The supraforaminal approach with a condylar positioning device appears to be an appropriate way to prevent injury to the inferior alveolar nerve during orthognathic surgery of the mandible while maintaining centric positioning of the condyle and obtaining good bony union.
如今，用于矫正下颌骨畸形最常见的正颌手术是双侧矢状劈开截骨术，也称为矢状升支截骨术。下颌神经（V3）的永久性损伤是主要并发症之一，报道的发生率在5%至30%之间。由于其复杂性以及对下牙槽神经造成损伤的相对高风险，以矢状升支截骨术作为首选术式的正颌手术应重新评估。应考虑采用能实现精确髁突定位且下牙槽神经损伤风险较低的手术技术。本研究的目的是呈现一组回顾性病例系列，采用先前描述的下颌升支水平截骨术以及现代技术进展，使该手术安全、可靠且可重复。
我们采用带有髁突定位装置、内窥镜和手术导航系统的改良方法进行下颌骨孔上水平斜行截骨术。该技术应用于连续17例患者。术后，我们测量了下颌骨的手术移动量，监测下颌神经，并在拆除接骨板期间评估骨愈合情况。
所有17例接受治疗的患者伤口均顺利愈合，且无患者出现永久性神经改变。下颌骨的平均移动量为7.48毫米（标准差，2.1毫米），范围为3.0至10.5毫米。平均随访时间为19个月。手术导航的主要目的是在手术过程中将计划的截骨线从计算机断层扫描转换到手术部位。这样做是为了防止截骨部位骨段之间出现大的间隙。
采用髁突定位装置的孔上入路似乎是在下颌骨正颌手术中防止下牙槽神经损伤的合适方法，同时保持髁突的中心定位并实现良好的骨愈合。
