Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital Aachen, Aachen, Germany.
Aesthetic Plast Surg. 2012 Jun;36(3):653-9. doi: 10.1007/s00266-012-9877-2. Epub 2012 Mar 7.
The intention of mandibular reconstructive surgery is to achieve maximum possible functionality, which means the restoration of masticatory function and speech with a good esthetic result.
We compared five computer-assisted mandibular reconstructions with 15 conventional mandibular reconstructions performed using vascularized iliac crest bone grafts. Based on preoperative cone beam computed tomography (CBCT) or CT data imported into the specific surgical planning software, a surgical guide was designed by rapid prototyping that helped to exactly translate the virtual surgery plan into the operation site whereby it fit uniquely to the iliac donor site. The ischemic time of the graft was measured intraoperatively and the difference between the amount of bone removed and the amount of bone required was determined. In addition, 3 months after surgery patients had to score the esthetics of their outer appearance using a visual analog scale.
In all patients the graft fit perfectly into the mandibular defect without major adjustments. The time for the shaping process of the transplant and the ischemic time were shorter than in the conventional grafting procedure. The virtual plan reduced the amount of bone removed to the required volume. The patients who underwent computer-assisted reconstruction had a higher degree of satisfaction with their outer appearance.
Our clinical experience and the collected data suggest that the described method is very promising for optimizing the surgical result of mandibular reconstructions using iliac crest bone grafts and achieving an excellent esthetic outcome.
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下颌骨重建的目的是实现最大可能的功能，这意味着恢复咀嚼功能和言语功能，并达到良好的美学效果。
我们比较了 5 例计算机辅助下颌骨重建和 15 例常规使用血管化髂嵴骨移植进行的下颌骨重建。根据术前锥形束 CT（CBCT）或 CT 数据导入特定的手术规划软件，通过快速原型设计了一个手术导板，有助于将虚拟手术计划准确地转化到手术部位，使其与髂骨供体部位独特匹配。术中测量移植物的缺血时间，并确定去除的骨量与所需骨量之间的差异。此外，术后 3 个月，患者需要使用视觉模拟量表对其外观的美观程度进行评分。
所有患者的移植物均完美地适配于下颌骨缺损，无需进行重大调整。移植体成型过程和缺血时间比传统移植程序更短。虚拟计划减少了去除的骨量，使其达到所需的体积。接受计算机辅助重建的患者对其外观的满意度更高。
我们的临床经验和收集的数据表明，该方法非常有前景，可以优化使用髂嵴骨移植进行下颌骨重建的手术结果，并达到出色的美学效果。
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