Department of Oral and Maxillofacial Surgery, Orbital Unit, Academic Medical Centre of Amsterdam, University of Amsterdam, Academic Centre for Dentistry (ACTA), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
Department of Oral and Maxillofacial Surgery, Orbital Unit, Academic Medical Centre of Amsterdam, University of Amsterdam, Academic Centre for Dentistry (ACTA), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
J Craniomaxillofac Surg. 2017 Jul;45(7):1043-1050. doi: 10.1016/j.jcms.2017.03.026. Epub 2017 Apr 20.
A novel surgical treatment sequence for secondary orbitozygomatic complex (OZC) reconstruction is described. Orbital reconstruction is performed before OZC repositioning. A surgical plan is made: the affected OZC is virtually osteotomized and aligned with a mirrored model of the unaffected OZC. A patient-specific implant (PSI) is designed for orbital reconstruction. Screw holes from the primary reconstruction are used for fixation. Primary screw hole positions at the repositioned OZC are embedded in the design, to guide OZC repositioning. A second patient-specific design is made for guidance at the zygomaticomaxillary buttress. The workflow was utilized in two patients. The PSI was positioned using navigation feedback. After repositioning of the zygomatic complex, the screw hole positions at the infraorbital rim and zygomaticomaxillary buttress seemed to align perfectly: no screw hole adjustments were necessary. Minor deviations were seen between planned and acquired PSI position; the mean errors between planned and acquired OZC position were 1.5 and 1.2 mm. Orbital reconstruction with a PSI before OZC repositioning ensures true-to-original orbital reconstruction. The use of old screw hole positions enables the PSI to be used as a static guide for OZC repositioning. The combination of static and dynamic guidance increases predictability in secondary OZC reconstruction.
描述了一种用于治疗继发眶颧复合体（OZC）重建的新型手术治疗顺序。先进行眼眶重建，然后再进行 OZC 复位。制定手术计划：虚拟地对受累的 OZC 进行截骨，并与未受累的 OZC 的镜像模型对齐。设计患者特定的植入物（PSI）进行眼眶重建。使用初次重建的螺钉孔进行固定。在重新定位的 OZC 上嵌入重新定位的 PSI 设计中的原始螺钉孔位置，以指导 OZC 重新定位。为颧上颌支柱设计第二个患者特定的设计以进行引导。该工作流程已在两名患者中使用。使用导航反馈定位 PSI。在重新定位颧骨复合体后，眶下缘和颧上颌支柱上的螺钉孔位置似乎完全对齐：无需调整螺钉孔。在计划的和获得的 PSI 位置之间观察到较小的偏差；计划的和获得的 OZC 位置之间的平均误差分别为 1.5 和 1.2 毫米。在重新定位 OZC 之前使用 PSI 进行眼眶重建可确保眼眶重建的原始准确性。使用旧的螺钉孔位置可使 PSI 用作 OZC 重新定位的静态引导。静态和动态引导的结合可提高继发 OZC 重建的可预测性。
