Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
J Craniomaxillofac Surg. 2012 Dec;40(8):660-4. doi: 10.1016/j.jcms.2011.11.001. Epub 2011 Dec 29.
Resorbable screw fixation for orthognathic surgery is widely used in oral and maxillofacial surgery and has several advantages. However, surgeons are concerned about using resorbable screws in orthognathic surgery because of possible postoperative complications such as relapse, screw fracture, and infection. The purpose of this study was to evaluate the skeletal stability of bicortical resorbable screw fixation after sagittal split ramus osteotomies for mandibular prognathism.
This study included 25 patients who underwent mandibular setback surgery fixed with resorbable screws after sagittal split osteotomy at the Department of Oral and Maxillofacial Surgery at Seoul National University Dental Hospital. Five resorbable screws (Inion CPS(®), Inion Ltd., Finland) were applied bicortically at each osteotomy site via a transbuccal approach. No rigid intermaxillary fixation was applied on the first postoperative day. Passive mouth opening exercises were allowed, using two light, rubber elastics for guidance. The control group was 25 patients fixed with four titanium screws. The follow-up period was 12-22 months (mean 17.8 months). Postoperative skeletal changes on lateral cephalometric radiographs were analyzed and compared between the two groups preoperatively, immediately postoperatively, and 6 months postoperatively.
The average setback was 6.9 mm and no major intraoperative complications occurred. One patient experienced infection immediately after surgery that was controlled uneventfully. The data did not demonstrate any significant difference in postoperative skeletal stability between the two groups. Differences between the immediate postoperative state and 6 months after surgery were not significant. In earlier cases, especially for patients with severe mandibular prognathism, immediate postoperative elastic traction was needed for stable occlusal guidance.
The results of this study indicate that bicortical resorbable screws offer a clinically stable outcome for the fixation of mandibular sagittal split osteotomies in mandibular prognathism. However the resorbable screws showed less stable results vertically than the titanium screws.
可吸收螺钉固定在正颌外科中应用广泛，具有许多优点。然而，由于可能发生术后并发症，如复发、螺钉断裂和感染，外科医生对在正颌手术中使用可吸收螺钉仍存在顾虑。本研究旨在评估可吸收螺钉在矢状劈开下颌骨截骨术治疗下颌前突中的骨稳定性。
本研究纳入 25 例在首尔国立大学牙科医院口腔颌面外科行矢状劈开截骨术后用可吸收螺钉固定的下颌后退患者。经颊侧入路，在每个骨切开部位双侧皮质各应用 5 枚可吸收螺钉（Inion CPS(®)，Inion Ltd.，芬兰）。术后第一天不使用颌间固定。允许进行被动张口练习，使用两条轻的橡胶弹性带进行引导。对照组为 25 例用 4 枚钛螺钉固定的患者。随访时间为 12-22 个月（平均 17.8 个月）。比较两组患者术前、术后即刻和术后 6 个月时的侧位头颅侧位片上的骨骼变化。
平均后退距离为 6.9mm，术中无重大并发症发生。1 例患者术后即刻发生感染，经治疗后痊愈。两组患者术后骨骼稳定性无显著差异。术后即刻与术后 6 个月时的差异无统计学意义。在早期病例中，尤其是对于下颌前突严重的患者，术后即刻需要弹性牵引来稳定咬合引导。
本研究结果表明，双侧皮质可吸收螺钉固定在下颌矢状劈开截骨术治疗下颌前突中具有临床稳定性。然而，与钛螺钉相比，可吸收螺钉在垂直方向上的稳定性较差。
