Dammous Sophie, Dupont Quentin, Gilles Roland
Department Head, Department of Oral and Maxillofacial Surgery, Clinique du Val de Sambre, Liège, Belgium.
Intern, Department of Oral and Maxillofacial Surgery, Clinique de l'Espérance, Liège, Belgium.
J Oral Maxillofac Surg. 2015 Jun;73(6):1169-80. doi: 10.1016/j.joms.2014.12.017. Epub 2014 Dec 23.
The purpose of this study was to observe the quality of the fracture line on the lingual side of the mandible after sagittal split osteotomy and the quality of pterygomaxillary separation after Le Fort I osteotomy using the BoneScalpel ultrasonic osteotome.
Bimaxillary procedures, according to the standard protocol, were performed using 10 fresh cadaver heads. The ultrasonic osteotome was used in the study group, and a reciprocating saw was used in the control group. Three-dimensional reconstructions of postoperative computed tomographic scans were obtained. The lingual ramus fracture pattern and the pterygomaxillary separation pattern were observed, classified, and compared. Postoperative dissections of the skulls were performed to assess the integrity of the infra-alveolar nerve and the descending palatine artery.
No significant differences were found in the cutting time of bone between the BoneScalpel and the sagittal saw. Of the sagittal split osteotomies in the study group, 90% showed a good pattern (vertical pattern of fracture line extending to the inferior border of the mandible running behind the mandibular canal) compared with 50% of the sagittal split osteotomies in the control group. Ideal separation of the pterygoid plates without fractures was observed in 80% of the Le Fort I osteotomies in the study group compared with 50% of the osteotomies in the control group. High-level fractures occurred in 30% of cases in the control group compared with none in the study group. The integrities of the infra-alveolar nerve and the descending palatine artery were preserved in all cases.
Use of the ultrasonic BoneScalpel did not require more time than the conventional method. An improved pattern of lingual fracture lines in mandibular sagittal split osteotomy procedures and the pattern of pterygomaxillary separation in Le Fort I osteotomy procedures were observed.
本研究旨在观察使用骨刀超声骨切开刀行下颌矢状劈开截骨术后下颌骨舌侧骨折线的质量以及Le Fort I型截骨术后翼上颌分离的质量。
按照标准方案，使用10个新鲜尸体头颅进行双颌手术。研究组使用超声骨切开刀，对照组使用往复锯。获得术后计算机断层扫描的三维重建图像。观察、分类并比较舌侧升支骨折模式和翼上颌分离模式。对颅骨进行术后解剖以评估下牙槽神经和腭降动脉的完整性。
骨刀超声骨切开刀与矢状锯在骨切割时间上无显著差异。研究组90%的下颌矢状劈开截骨术显示出良好模式（骨折线垂直模式延伸至下颌管后方的下颌骨下缘），而对照组为50%。研究组80%的Le Fort I型截骨术观察到翼突板理想分离且无骨折，而对照组为50%。对照组30%的病例发生高位骨折，而研究组无此情况。所有病例中下牙槽神经和腭降动脉的完整性均得以保留。
使用超声骨刀所需时间并不比传统方法长。观察到下颌矢状劈开截骨术舌侧骨折线模式及Le Fort I型截骨术翼上颌分离模式有所改善。
