Fu Xi, Qiao Jia, Girod Sabine, Niu Feng, Liu Jian Feng, Lee Gordon K, Gui Lai
From the *The Craniofacial Center One, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; and †Plastic and Reconstructive Surgery, Stanford, Palo Alto, CA.
Ann Plast Surg. 2017 Sep;79(3):236-242. doi: 10.1097/SAP.0000000000001149.
Mandible contour surgery, including reduction gonioplasty and genioplasty, has become increasingly popular in East Asia. However, it is technically challenging and, hence, leads to a long learning curve and high complication rates and often needs secondary revisions. The increasing use of 3-dimensional (3D) technology makes accurate single-stage mandible contour surgery with minimum complication rates possible with a virtual surgical plan (VSP) and 3-D surgical templates. This study is to establish a standardized protocol for VSP and 3-D surgical templates-assisted mandible contour surgery and evaluate the accuracy of the protocol.
In this study, we enrolled 20 patients for mandible contour surgery. Our protocol is to perform VSP based on 3-D computed tomography data. Then, design and 3-D print surgical templates based on preoperative VSP. The accuracy of the method was analyzed by 3-D comparison of VSP and postoperative results using detailed computer analysis.
All patients had symmetric, natural osteotomy lines and satisfactory facial ratios in a single-stage operation. The average relative error of VSP and postoperative result on the entire skull was 0.41 ± 0.13 mm. The average new left gonial error was 0.43 ± 0.77 mm. The average new right gonial error was 0.45 ± 0.69 mm. The average pognion error was 0.79 ± 1.21 mm. Patients were very satisfied with the aesthetic results. Surgeons were very satisfied with the performance of surgical templates to facilitate the operation.
Our standardized protocol of VSP and 3-D printed surgical templates-assisted single-stage mandible contour surgery results in accurate, safe, and predictable outcome in a single stage.
下颌骨轮廓手术，包括下颌角缩小成形术和颏成形术，在东亚地区越来越受欢迎。然而，该手术技术难度大，因此学习曲线长，并发症发生率高，且常需二次修复。三维（3D）技术的日益普及使得通过虚拟手术计划（VSP）和3D手术模板实现准确率高、并发症发生率低的单阶段下颌骨轮廓手术成为可能。本研究旨在建立VSP和3D手术模板辅助下颌骨轮廓手术的标准化方案，并评估该方案的准确性。
在本研究中，我们招募了20例接受下颌骨轮廓手术的患者。我们的方案是基于三维计算机断层扫描数据进行VSP。然后，根据术前VSP设计并3D打印手术模板。通过使用详细的计算机分析对VSP和术后结果进行三维比较来分析该方法的准确性。
所有患者在单阶段手术中均获得了对称、自然的截骨线和满意的面部比例。整个颅骨上VSP与术后结果的平均相对误差为0.41±0.13毫米。新的左侧下颌角平均误差为0.43±0.77毫米。新的右侧下颌角平均误差为0.45±0.69毫米。颏点平均误差为0.79±1.21毫米。患者对美学效果非常满意。外科医生对手术模板便于手术操作的性能非常满意。
我们的VSP和3D打印手术模板辅助单阶段下颌骨轮廓手术的标准化方案在单阶段手术中可产生准确、安全且可预测的结果。
