Miloro Michael, Markiewicz Michael R
Professor and Head, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL.
Assistant Professor, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Illinois at Chicago, and Member, Cancer Center, University of Illinois Medical Center, Chicago, IL.
J Oral Maxillofac Surg. 2017 Nov;75(11):2442-2448. doi: 10.1016/j.joms.2017.04.001. Epub 2017 Apr 12.
The purpose of this study was to assess the outcomes after preoperative virtual surgical planning (VSP) for inferior alveolar nerve (IAN) reconstruction in ablative mandibular surgery.
We performed a retrospective evaluation of consecutive surgical cases using standard VSP for hard tissue resection and reconstructive surgery in addition to IAN VSP performed simultaneously during surgery. Cases were assessed regarding the planning time, additional costs involved, surgeon's subjective impression of the process, accuracy of the prediction during surgery, and operative time during surgery compared with cases performed without VSP.
The study sample was composed of 5 cases of mandibular resection for benign disease, with bony, soft tissue, and neural reconstruction with the use of VSP. The addition of IAN reconstruction to the VSP session added no additional expense to the planning session but resulted in an additional 22.5 minutes (±7.5 minutes) for the webinar session. From a subjective standpoint, IAN VSP provided the surgeon with a discreet plan for surgery. From an objective standpoint, IAN VSP provided the exact length and diameter of nerve graft required for surgery, facilitated the surgeon's ability to visualize the actual nerve graft procedure, and limited the additional time required for simultaneous nerve reconstruction.
Despite perceived prejudice against simultaneous IAN reconstruction with complex mandibular resection and reconstruction, the use of IAN VSP may facilitate the actual surgical procedure and result in considerably improved patient outcomes without considerable additional time or cost associated with this protocol.
本研究旨在评估在切除性下颌骨手术中，术前虚拟手术规划（VSP）用于下牙槽神经（IAN）重建后的效果。
我们对连续的手术病例进行了回顾性评估，这些病例除了在手术期间同时进行IAN VSP外，还使用标准VSP进行硬组织切除和重建手术。与未进行VSP的病例相比，评估了病例的规划时间、涉及的额外费用、外科医生对该过程的主观印象、手术期间预测的准确性以及手术时间。
研究样本包括5例因良性疾病进行下颌骨切除的病例，采用VSP进行骨、软组织和神经重建。在VSP环节增加IAN重建并未给规划环节增加额外费用，但网络研讨会环节增加了22.5分钟（±7.5分钟）。从主观角度看，IAN VSP为外科医生提供了一个谨慎的手术方案。从客观角度看，IAN VSP提供了手术所需神经移植物的确切长度和直径，有助于外科医生直观了解实际的神经移植过程，并减少了同时进行神经重建所需的额外时间。
尽管人们认为在复杂的下颌骨切除和重建手术中同时进行IAN重建存在偏见，但使用IAN VSP可能会促进实际手术过程，并在不增加该方案所需的大量额外时间或成本的情况下，显著改善患者预后。
