Fujii H, Kuroyanagi N, Kanazawa T, Yamamoto S, Miyachi H, Shimozato K
Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi Gakuin Dental Hospital, Nagoya, Aichi, Japan.
Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi Gakuin Dental Hospital, Nagoya, Aichi, Japan; Department of Oral and Maxillofacial Surgery, Hekinan Municipal Hospital, Hekinan, Aichi, Japan.
Int J Oral Maxillofac Surg. 2017 May;46(5):564-571. doi: 10.1016/j.ijom.2016.12.009. Epub 2017 Jan 12.
The aim of this study was to determine whether non-linear three-dimensional finite element analysis (3D-FEA) can be applied to simulate pterygomaxillary dysjunction during Le Fort I osteotomy (LFI) not involving a curved osteotome (LFI-non-COSep), and to predict potential changes in the fracture pattern associated with extending the cutting line. Computed tomography (CT) image data (100 snapshots) after LFI were converted to 3D-CT images. 3D-FEA models were built using preoperative CT matrix data and used to simulate pterygomaxillary dysjunction. The pterygomaxillary dysjunction patterns predicted by the 3D-FEA models of pterygomaxillary dysjunction were classified into three categories and compared to the pterygomaxillary dysjunction patterns observed in the postoperative 3D-CT images. Extension of the cutting line was also simulated using the 3D-FEA models to predict the risk and position of pterygoid process fracture. The rate of agreement between the predicted pterygomaxillary dysjunction patterns and those observed in the postoperative 3D-CT images was 87.0% (κ coefficient 0.79). The predicted incidence of pterygoid process fracture was higher for cutting lines that extended to the pterygomaxillary junction than for conventional cutting lines (odds ratio 4.75; P<0.0001). 3D-FEA can be used to predict pterygomaxillary dysjunction patterns during LFI-non-COSep and provides useful information for selecting safer procedures during LFI-non-COSep.
本研究的目的是确定非线性三维有限元分析（3D-FEA）是否可用于模拟不涉及弯形骨刀的Le Fort I型截骨术（LFI）期间的翼上颌分离（LFI-non-COSep），并预测与延长切割线相关的骨折模式的潜在变化。LFI术后的计算机断层扫描（CT）图像数据（100张快照）被转换为三维CT图像。使用术前CT矩阵数据建立3D-FEA模型，并用于模拟翼上颌分离。将翼上颌分离的3D-FEA模型预测的翼上颌分离模式分为三类，并与术后三维CT图像中观察到的翼上颌分离模式进行比较。还使用3D-FEA模型模拟切割线的延长，以预测翼突骨折的风险和位置。预测的翼上颌分离模式与术后三维CT图像中观察到的模式之间的一致率为87.0%（κ系数0.79）。延伸至翼上颌交界处的切割线的翼突骨折预测发生率高于传统切割线（优势比4.75；P<0.0001）。3D-FEA可用于预测LFI-non-COSep期间的翼上颌分离模式，并为在LFI-non-COSep期间选择更安全的手术提供有用信息。
