From the Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University.
Plast Reconstr Surg. 2019 Aug;144(2):246e-251e. doi: 10.1097/PRS.0000000000005858.
Orthognathic surgery is a powerful tool for correction of facial asymmetry and malocclusion. The goal is to achieve good dental function and facial aesthetics. Three-dimensional simulation is used for surgical planning, and bone gaps could be created to achieve facial balance. In this study, customized "spacers" were made using computer-aided design and three-dimensional printing for guides for use during surgery. With the final three-dimensional plan, the skull images were exported to 3-Matic software, where spacers were designed according to the bone gaps. Three-dimensionally-printed spacers were made and used to facilitate positioning and fixation. Consecutive patients with facial asymmetry were recruited in this prospective study. The postoperative outcome was assessed using a visual analogue scale and the three-dimensional facial surface area discrepancy index for subjective and objective evaluation. There were 12 patients and a total of 19 spacers for the Le Fort I and mandibular ramus segments. The spacers worked nicely during the bone fixation process. Mean preoperative and postoperative visual analogue scale scores were 4.83 and 7.14, with a statistically significant improvement for facial symmetry (p = 0.018). Mean preoperative and postoperative facial surface area discrepancy index was 0.95 and 0.98, and the correction of asymmetry was significant (p = 0.009). There were no related surgical complications. All patients were satisfied with the correction of facial asymmetry and malocclusion. The custom-made, three-dimensionally-printed spacers help to achieve surgical precision to correct and prevent facial asymmetry in orthognathic surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.
正颌手术是矫正面部不对称和咬合不正的有力工具。其目标是实现良好的牙齿功能和面部美观。三维模拟用于手术规划，可以创建骨间隙以实现面部平衡。在这项研究中，使用计算机辅助设计和三维打印制作了定制的“间隔物”，作为手术期间的引导器。根据最终的三维计划，将颅骨图像导出到 3-Matic 软件中，根据骨间隙设计间隔物。制作了三维打印的间隔物，用于辅助定位和固定。本前瞻性研究纳入了连续的面部不对称患者。使用视觉模拟评分和三维面部表面积差异指数对术后结果进行主观和客观评估。共有 12 名患者，总共涉及 19 个 Le Fort I 和下颌支段的间隔物。间隔物在骨固定过程中效果良好。术前和术后平均视觉模拟评分分别为 4.83 和 7.14，面部对称性有显著改善（p = 0.018）。术前和术后平均面部表面积差异指数分别为 0.95 和 0.98，不对称的矫正具有统计学意义（p = 0.009）。无相关手术并发症。所有患者均对面部不对称和咬合不正的矫正效果满意。定制的三维打印间隔物有助于实现手术精度，以矫正和预防正颌手术中的面部不对称。临床问题/证据水平：治疗，IV。
