Pauchot J, Lachat J, Floret F, Badet J-M, Tavernier L, Aubry S
Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CHU de Besançon, 25033 Besançon cedex, France; EA 4268 innovation, imagerie, ingénierie et intervention en santé « I4S », IFR 133 Inserm, faculté de médecine et de pharmacie, université de Franche-Comté, 25030 Besançon cedex, France.
AIP-Primeca de Franche-Comté, ENSMM, 26, rue de l'épitaphe, 25030 Besançon cedex, France.
Rev Stomatol Chir Maxillofac Chir Orale. 2013 Sep;114(4):269-275. doi: 10.1016/j.revsto.2013.06.002. Epub 2013 Aug 6.
Mandibular reconstruction with fibula free flap harvest is currently the reference technique. Various preoperative processes have been developed to optimize this reconstruction. We report our experience with a simple, inexpensive, preoperative technique requiring a 3D printer, a device for maintaining mandibular reduction, a paper-cutting guide.
Stereomodels of the mandible were obtained from computed tomography scan data and printed 3D in ABS. It allowed planning mandibular osteotomies, determine the angle between two bone fragments, and preoperatively modeling the osteosynthesis plate. A paper-cutting guide, and a simple device for maintaining mandibular reduction were also built. Two patients were operated on with this technique, with follow-up at 6 and 8 months. Reconstructions were successful with good clinical outcome in terms of mandibular contour and reconstructed segments positions.
Preoperative planning of reconstruction may be used for mandibular osteotomies, fibular osteotomies, maintaining mandibular reduction, osteosynthesis, or placing implants for dental rehabilitation. The most complex procedures can virtually plan all these steps, but they are expensive and long to implement. Nevertheless, such procedures are quite expansive and require time not always compatible with carcinoma. Using a mandibular stereomodel is fast, easy, and cheap.
游离腓骨瓣移植下颌骨重建目前是参考技术。已开发出各种术前流程以优化这种重建。我们报告了一种简单、廉价的术前技术的经验，该技术需要一台3D打印机、一种维持下颌骨复位的装置和一个剪纸导板。
下颌骨的立体模型由计算机断层扫描数据获得，并以ABS材料进行3D打印。这有助于规划下颌骨截骨术、确定两块骨碎片之间的角度，并在术前对接骨板进行建模。还制作了一个剪纸导板和一个简单的维持下颌骨复位的装置。两名患者采用该技术进行手术，随访6个月和8个月。在重建下颌轮廓和重建节段位置方面，重建成功且临床效果良好。
重建的术前规划可用于下颌骨截骨术、腓骨截骨术、维持下颌骨复位、接骨或植入牙修复体。最复杂的程序实际上可以规划所有这些步骤，但它们成本高昂且实施时间长。然而，此类程序相当昂贵，且所需时间有时与癌症治疗不兼容。使用下颌骨立体模型快速、简便且成本低廉。
