Li Biao, Zhang Lei, Sun Hao, Shen Steve G F, Wang Xudong
From the Department of Oral and Cranio-maxillofacial Science of Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University at Shanghai, and Shanghai Key Laboratory of Stomatology at Shanghai, Shanghai, China.
J Craniofac Surg. 2014 Mar;25(2):406-11. doi: 10.1097/SCS.0000000000000673.
In bimaxillary orthognathic surgery, the positioning of the maxilla and the mandible is typically accomplished via 2-splint technique, which may be the sources of several types of inaccuracy. To overcome the limitations of the 2-splint technique, we developed a new navigation method, which guided the surgeon to free-hand reposition the maxillomandibular complex as a whole intraoperatively, without the intermediate splint. In this preliminary study, the feasibility was demonstrated. Five patients with dental maxillofacial deformities were enrolled. Before the surgery, 3-dimensional planning was conducted and imported into a navigation system. During the operation, a tracker was connected to the osteotomized maxillomandibular complex via a splint. The navigation system tracked the movement of the complex and displayed it on the screen in real time to guide the surgeon to reposition the complex. The postoperative result was compared with the plan by analyzing the measured distances between the maxillary landmarks and reference planes, as determined from computed tomography data. The mean absolute errors of the maxillary position were clinically acceptable (<1.0 mm). Preoperative preparation time was reduced to 100 minutes on average. All patients were satisfied with the aesthetic results. This navigation method without intraoperative image registration provided a feasible means of transferring virtual planning to the real orthognathic surgery. The real-time position of the maxillomandibular complex was displayed on a monitor to visually guide the surgeon to reposition the complex. In this method, the traditional model surgery and the intermediate splint were discarded, and the preoperative preparation was simplified.
在双颌正颌手术中,上颌骨和下颌骨的定位通常通过双夹板技术完成,这可能是多种误差的来源。为了克服双夹板技术的局限性,我们开发了一种新的导航方法,该方法可在术中引导外科医生徒手将上颌下颌复合体作为一个整体重新定位,无需中间夹板。在这项初步研究中,证明了其可行性。招募了5例牙颌面畸形患者。手术前,进行三维规划并导入导航系统。手术过程中,通过夹板将跟踪器连接到截骨后的上颌下颌复合体。导航系统跟踪复合体的移动并实时显示在屏幕上,以引导外科医生重新定位复合体。通过分析计算机断层扫描数据确定的上颌标志点与参考平面之间的测量距离,将术后结果与计划进行比较。上颌位置的平均绝对误差在临床上是可接受的(<1.0毫米)。术前准备时间平均减少到100分钟。所有患者对美学效果都很满意。这种无需术中图像配准的导航方法为将虚拟规划转移到实际正颌手术提供了一种可行的手段。上颌下颌复合体的实时位置显示在监视器上,以视觉方式引导外科医生重新定位复合体。在这种方法中,摒弃了传统的模型手术和中间夹板,简化了术前准备。