Erkan Mustafa, Ulkur Ersin, Karagoz Huseyin, Karacay Seniz, Basaran Guvenc, Sonmez Guner
Department of Orthodontics, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey.
J Craniofac Surg. 2011 Jul;22(4):1336-41. doi: 10.1097/SCS.0b013e31821c930b.
The aim of this report was to present the orthognathic surgical planning of a patient with maxillary retrusion, mandibular prognathism, and midline shift on a three-dimensional stereolithographic biomodel. A patient who complained about facial deformity and difficulty in chewing was referred to our department. After a short-term presurgical orthodontic treatment, Le Fort I osteotomy and bilateral sagittal split ramus osteotomy were performed. Triangular axial gaps occurred anteriorly and posteriorly between the proximal and distal segments of the osteotomized mandible. These gaps were filled with bone grafts in accordance with templates that were constructed on a three-dimensional stereolithographic biomodel. Rotational movement of the distal mandibular segment around the y axis caused axial triangular gapping between the proximal and distal mandibular segments. In the presented case, orthognathic surgical planning was performed on the three-dimensional solid models, and templates were reconstructed according to these gaps. These templates were used to determine the size of the bone grafts during the surgical approach. The patient was diagnosed with lateral cephalometric and posteroanterior cephalometric analysis in postretention for 2 years, and it was determined that long-term results were perfect and skeletal relapse did not occur after 2.5 years of surgery. Movement at the site of the osteotomy is usually the main cause of relapse after orthognathic surgery. In the presented case, a three-dimensional stereolithographic biomodel was used to plan the orthognathic surgery and to reconstruct the templates to determine the size and shape of the bone grafts. Using bone grafts established close contact between proximal and distal osteotomized bone segments, enhanced bone healing, and diminished relapse risk.
本报告的目的是展示一名上颌后缩、下颌前突且中线偏移患者在三维立体光刻生物模型上的正颌外科手术规划。一名主诉面部畸形和咀嚼困难的患者被转诊至我科。经过短期术前正畸治疗后，实施了Le Fort I截骨术和双侧矢状劈开下颌支截骨术。截骨后的下颌骨近端和远端节段之间前后出现了三角形轴向间隙。这些间隙根据在三维立体光刻生物模型上构建的模板用骨移植填充。下颌骨远端节段绕y轴的旋转运动导致下颌骨近端和远端节段之间出现轴向三角形间隙。在本病例中，在三维实体模型上进行正颌外科手术规划，并根据这些间隙重建模板。这些模板在手术过程中用于确定骨移植的大小。患者在保持2年后进行了侧位头影测量和后前位头影测量分析，结果显示2.5年手术后长期效果良好，未发生骨骼复发。截骨部位的移动通常是正颌手术后复发的主要原因。在本病例中，使用三维立体光刻生物模型规划正颌手术并重建模板，以确定骨移植的大小和形状。使用骨移植可使截骨后的近端和远端骨段紧密接触，促进骨愈合，并降低复发风险。
