Yen Cheng-I, Zelken Jonathan A, Chang Chun-Shin, Lo Lun-Jou, Yang Jui-Yung, Chuang Shiow-Shuh, Araniego Cheryl A, Hsiao Yen-Chang
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5, Fu-Xing Street, Guishan, Taoyuan, Taipei 333, Taiwan.
Zelken Institute for Aesthetic Medicine, Newport Beach, CA, USA.
J Plast Reconstr Aesthet Surg. 2019 Jul;72(7):1198-1206. doi: 10.1016/j.bjps.2019.03.012. Epub 2019 Mar 25.
Symmetry and balance in nasal reconstruction can be hard to achieve. Traditionally, a foil template modeled after the unaffected contralateral side is used in the design of a forehead flap. Crude two-dimensional models often generate underwhelming results. To better simulate complex nasal topography, three-dimensional printing technology was applied to nasal reconstruction.
Between May 2012 and October 2016, twenty patients underwent forehead flap nasal reconstruction for heminasal deformities. Ten reconstructions were guided with prefabricated three-dimensional templates (CAD/CAM), and ten patients underwent traditional nasal reconstruction without CAD/CAM. In the CAD/CAM group, two templates were printed: contour guide and framework guide. These were a reference for skin flap design and cartilage framework design, respectively. Photographic records and photogrammetry was used to evaluate results.
The mean follow-up time was 19.3 months (range, 6 months to 38 months) in the control group and 17.4 months (range, 7 months to 35 months) in the CAD/CAM group. Without CAD/CAM, there was asymmetry in alar width, alar area, nostril height, width and area (p < 0.05) between reconstructed and native structures. In the CAD/CAM group, there were asymmetries of nostril-related parameters only. After quantifying asymmetries as a percentage, the CAD/CAM group demonstrated more symmetric reconstructions, particularly in alar width (p = 0.043) and alar area (p = 0.003).
When CAD/CAM guidance and three-dimensional printing was used, there was greater symmetry between reconstructed and native structures of the nose.
鼻再造术中的对称性和平衡性很难实现。传统上，在前额皮瓣设计中使用以未受影响的对侧为模型制作的箔模板。粗糙的二维模型往往产生不尽人意的结果。为了更好地模拟复杂的鼻腔形态，三维打印技术被应用于鼻再造。
2012年5月至2016年10月，20例患者因半鼻畸形接受前额皮瓣鼻再造术。10例再造手术采用预制三维模板（CAD/CAM）引导，10例患者接受无CAD/CAM的传统鼻再造。在CAD/CAM组，打印了两个模板：轮廓引导模板和框架引导模板。它们分别作为皮瓣设计和软骨框架设计的参考。采用摄影记录和摄影测量法评估结果。
对照组平均随访时间为19.3个月（范围6个月至38个月），CAD/CAM组为17.4个月（范围7个月至35个月）。未使用CAD/CAM时，再造结构与原生结构在鼻翼宽度、鼻翼面积、鼻孔高度、宽度和面积方面存在不对称（p<0.05）。在CAD/CAM组，仅鼻孔相关参数存在不对称。将不对称量化为百分比后，CAD/CAM组的再造更对称，尤其是在鼻翼宽度（p = 0.043）和鼻翼面积（p = 0.003）方面。
使用CAD/CAM引导和三维打印时，鼻再造结构与原生结构之间具有更高的对称性。
