优化面颌牙移植中的混合咬合：实时头影测量作为颅颌面外科计算机辅助规划与执行工作站一部分的初步评估
Optimizing Hybrid Occlusion in Face-Jaw-Teeth Transplantation: A Preliminary Assessment of Real-Time Cephalometry as Part of the Computer-Assisted Planning and Execution Workstation for Craniomaxillofacial Surgery.
作者信息
Murphy Ryan J, Basafa Ehsan, Hashemi Sepehr, Grant Gerald T, Liacouras Peter, Susarla Srinivas M, Otake Yoshito, Santiago Gabriel, Armand Mehran, Gordon Chad R
机构信息
Laurel, Baltimore, and Bethesda, Md.; and Boston, Mass. From the Johns Hopkins University Applied Physics Laboratory; the Department of Mechanical Engineering, Johns Hopkins University; the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine; Craniofacial Imaging, Naval Postgraduate Dental School, 3D Medical Center, and the Department of Ear, Nose, and Throat-Head and Neck Surgery, Walter Reed National Medical Center; and Harvard School of Dental Medicine/Harvard Medical School.
出版信息
Plast Reconstr Surg. 2015 Aug;136(2):350-362. doi: 10.1097/PRS.0000000000001455.
BACKGROUND
The aesthetic and functional outcomes surrounding Le Fort-based, face-jaw-teeth transplantation have been suboptimal, often leading to posttransplant class II/III skeletal profiles, palatal defects, and "hybrid malocclusion." Therefore, a novel technology-real-time cephalometry-was developed to provide the surgical team instantaneous, intraoperative knowledge of three-dimensional dentoskeletal parameters.
METHODS
Mock face-jaw-teeth transplantation operations were performed on plastic and cadaveric human donor/recipient pairs (n = 2). Preoperatively, cephalometric landmarks were identified on donor/recipient skeletons using segmented computed tomographic scans. The computer-assisted planning and execution workstation tracked the position of the donor face-jaw-teeth segment in real time during the placement/inset onto recipient, reporting pertinent hybrid cephalometric parameters from any movement of donor tissue. The intraoperative data measured through real-time cephalometry were compared to posttransplant measurements for accuracy assessment. In addition, posttransplant cephalometric relationships were compared to planned outcomes to determine face-jaw-teeth transplantation success.
RESULTS
Compared with postoperative data, the real-time cephalometry-calculated intraoperative measurement errors were 1.37 ± 1.11 mm and 0.45 ± 0.28 degrees for the plastic skull and 2.99 ± 2.24 mm and 2.63 ± 1.33 degrees for the human cadaver experiments. These results were comparable to the posttransplant relations to planned outcome (human cadaver experiment, 1.39 ± 1.81 mm and 2.18 ± 1.88 degrees; plastic skull experiment, 1.06 ± 0.63 mm and 0.53 ± 0.39 degrees).
CONCLUSION
Based on this preliminary testing, real-time cephalometry may be a valuable adjunct for adjusting and measuring "hybrid occlusion" in face-jaw-teeth transplantation and other orthognathic surgical procedures.
背景
基于勒福式面颌牙移植的美学和功能效果一直不尽人意，常常导致移植后出现Ⅱ类/Ⅲ类骨骼轮廓、腭部缺损和“混合错牙合”。因此，开发了一种新技术——实时头影测量法，以便为手术团队提供三维牙颌面骨骼参数的术中即时信息。
方法
在塑料模型和人体尸体供体/受体对（n = 2）上进行模拟面颌牙移植手术。术前，使用断层计算机扫描在供体/受体骨骼上确定头影测量标志点。计算机辅助规划和执行工作站在将供体面颌牙段放置/嵌入受体的过程中实时跟踪其位置，报告供体组织任何移动时的相关混合头影测量参数。将通过实时头影测量法测得的术中数据与移植后的测量数据进行比较，以评估准确性。此外，将移植后的头影测量关系与计划结果进行比较，以确定面颌牙移植的成功率。
结果
与术后数据相比，实时头影测量法计算得出的术中测量误差在塑料颅骨实验中为1.37±1.11毫米和0.45±0.28度，在人体尸体实验中为2.99±2.24毫米和2.63±1.33度。这些结果与移植后与计划结果的关系相当（人体尸体实验为1.39±1.81毫米和2.18±1.88度；塑料颅骨实验为1.06±0.63毫米和0.53±0.39度）。
结论
基于这项初步测试，实时头影测量法可能是调整和测量面颌牙移植及其他正颌外科手术中“混合咬合”的一种有价值的辅助方法。
Zotero 插件