Pirgousis Phillip, Brown Desmond, Fernandes Rui
Chief Resident, Department of Oral and Maxillofacial Surgery, Section of Head and Neck and Reconstructive Surgery, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Florida College of Medicine, Jacksonville, FL.
J Oral Maxillofac Surg. 2013 Dec;71(12):2169-75. doi: 10.1016/j.joms.2013.05.005. Epub 2013 Aug 12.
Mandibular reconstruction continues to be a challenge, even for the seasoned reconstructive surgeon. The present study sought to determine the normal anatomic mandibular angle and to establish a predictable angle of resection for the fibula bone cut to re-create the neomandibular body-ascending ramus angle.
A total of 30 random male and female panoramic radiographs were selected from our database. The selection criteria included age older than 21 years and a full or near total complement of teeth. The exclusion criteria were an edentulous mandible or maxilla, a history of trauma or maxillary or mandibular pathologic features, and age younger than 21 years. A total of 120 total measurements were performed. The angle measured was determined from a line coinciding with the posterior border of the ramus and the lower mandibular border. The measurements were taken from each side and from each gender group. The institutional review board of our institution approved the present study.
The mean female mandibular right angle was 122.62°, and the left was 124.59° (average, 123.61°). The mean male mandibular right angle was 122.66°, and the left was 124.2° (average, 123.43°). The mean and median values were very similar. A statistically significant difference was identified between the left and right sides but not between the genders. Given this information, one can calculate a wedge cut in the fibula of about 56° to re-create the mean mandibular angle.
This information can be used to make predictable fibula wedge closing osteotomies to re-create the normal mandibular ascending ramus body angle in a low-cost manner with the aid of an autoclavable metal wedge of 56°. This method would obviate the need for costly prefabricated guides.
即使对于经验丰富的重建外科医生而言，下颌骨重建仍是一项挑战。本研究旨在确定正常的下颌骨解剖角度，并为腓骨截骨建立一个可预测的角度，以重新构建新下颌骨体-升支角度。
从我们的数据库中随机选取了30张男女全景X线片。选择标准包括年龄大于21岁且牙齿完整或接近完整。排除标准为无牙下颌骨或上颌骨、有创伤史或上颌或下颌病理特征以及年龄小于21岁。总共进行了120次测量。测量的角度是由与升支后缘和下颌下缘重合的线确定的。测量分别取自每一侧和每个性别组。我们机构的机构审查委员会批准了本研究。
女性下颌骨右侧平均角度为122.62°，左侧为124.59°（平均，123.61°）。男性下颌骨右侧平均角度为122.66°，左侧为124.2°（平均，123.43°）。均值和中位数非常相似。在左右两侧之间发现了统计学上的显著差异，但在性别之间未发现。根据这些信息，可以计算出腓骨上约56°的楔形截骨，以重新构建平均下颌骨角度。
该信息可用于进行可预测的腓骨楔形闭合截骨术，借助56°的可高压灭菌金属楔形物以低成本方式重新构建正常的下颌骨升支体角度。这种方法将无需使用昂贵的预制导向器。
