Pakdel Amir R, Whyne Cari M, Fialkov Jeffrey A
Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada.
Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Plast Reconstr Aesthet Surg. 2017 Jun;70(6):842-850. doi: 10.1016/j.bjps.2017.01.021. Epub 2017 Feb 17.
The trend towards optimizing stabilization of the craniomaxillofacial skeleton (CMFS) with the minimum amount of fixation required to achieve union, and away from maximizing rigidity, requires a quantitative understanding of craniomaxillofacial biomechanics. This study uses computational modeling to quantify the structural biomechanics of the CMFS under maximal physiologic masticatory loading.
Using an experimentally validated subject-specific finite element (FE) model of the CMFS, the patterns of stress and strain distribution as a result of physiological masticatory loading were calculated. The trajectories of the stresses were plotted to delineate compressive and tensile regimes over the entire CMFS volume.
The lateral maxilla was found to be the primary vertical buttress under maximal bite force loading, with much smaller involvement of the naso-maxillary buttress. There was no evidence that the pterygo-maxillary region is a buttressing structure, counter to classical buttress theory. The stresses at the zygomatic sutures suggest that two-point fixation of zygomatic complex fractures may be sufficient for fixation under bite force loading.
The current experimentally validated biomechanical FE model of the CMFS is a practical tool for in silico optimization of current practice techniques and may be used as a foundation for the development of design criteria for future technologies for the treatment of CMFS injury and disease.
颅颌面骨骼（CMFS）稳定化的趋势是用实现骨愈合所需的最少固定量来优化，而非追求最大刚度，这需要对颅颌面生物力学有定量的理解。本研究采用计算建模来量化在最大生理性咀嚼负荷下CMFS的结构生物力学。
使用经过实验验证的CMFS个体特异性有限元（FE）模型，计算生理性咀嚼负荷导致的应力和应变分布模式。绘制应力轨迹以描绘整个CMFS体积内的压缩和拉伸区域。
发现在最大咬合力负荷下，上颌骨外侧是主要的垂直支柱，鼻上颌支柱的参与程度要小得多。没有证据表明翼上颌区域是一个支撑结构，这与经典支撑理论相反。颧骨缝处的应力表明，颧骨复合体骨折的两点固定在咬合力负荷下可能足以实现固定。
当前经过实验验证的CMFS生物力学FE模型是用于对当前实践技术进行计算机模拟优化的实用工具，可作为制定未来治疗CMFS损伤和疾病技术设计标准的基础。
