Liu K, Sun H, Zhang L, Li B, Chakraborty S, Wang X
Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology,National Clinical Research Center for Oral Diseases, Shanghai, China.
Columbia Asia Hospital, Kolkata, India.
Br J Oral Maxillofac Surg. 2020 Jun;58(5):590-596. doi: 10.1016/j.bjoms.2020.02.021. Epub 2020 Mar 7.
The aim of this retrospective study was to use computer-aided design and manufacturing (CAD/CAM) patient-specific plates and cutting guides for the waferless positioning and fixation of the maxilla after bimaxillary osteotomies in cases of hemifacial microsomia with condylar dysplasia or absence of the temporomandibular joint (TMJ), and to compare the results with the CAD/CAM fabricated surgical wafer by 3-dimensional analysis. Eighteen patients were selected from the hospital database, preoperative surgical planning and simulation were done on 3-dimensional computed tomographic models for all patients, and they were divided into Group I - in which CAD/CAM patient-specific cutting guides and plates were used; and Group II - in which CAD/CAM fabricated surgical wafers were used. Finally, the outcome was evaluated by comparing planned with postoperative outcomes. The largest discrepancies of the Le Fort I segment were 0.50 (0.18) mm in the anteroposterior direction and 0.82 (0.60)° in the yaw orientation with Group I. The largest discrepancies of the Le Fort I segment were 1.32 (1.40) mm in superioinferior direction and 8.48 (7.73)° in the yaw orientation with Group II. The CAD/CAM patient-specific cutting guides and plates proved to be reliable and have great value in improving the accuracy in repositioning the Le Fort I segment and in the efficacy of orthognathic treatment of hemifacial microsomia with condylar dysplasia or no TMJ. The CAD/CAM patient-specific cutting guides and plates are therefore a useful alternative to the wafer technique.
本回顾性研究的目的是使用计算机辅助设计与制造（CAD/CAM）的患者特异性钢板和切割导板，用于在伴有髁突发育不良或颞下颌关节（TMJ）缺失的半侧颜面短小畸形病例中，进行双颌截骨术后上颌骨的无导板定位和固定，并通过三维分析将结果与CAD/CAM制作的手术导板进行比较。从医院数据库中选取18例患者，对所有患者的三维计算机断层扫描模型进行术前手术规划和模拟，并将他们分为两组：第一组使用CAD/CAM患者特异性切割导板和钢板；第二组使用CAD/CAM制作的手术导板。最后，通过比较计划结果与术后结果来评估疗效。第一组中，Le Fort I节段在前后方向上的最大差异为0.50（0.18）mm，在偏航方向上为0.82（0.60）°。第二组中，Le Fort I节段在上下方向上的最大差异为1.32（1.40）mm，在偏航方向上为8.48（7.73）°。CAD/CAM患者特异性切割导板和钢板被证明是可靠的，在提高Le Fort I节段重新定位的准确性以及治疗伴有髁突发育不良或无TMJ的半侧颜面短小畸形的正颌治疗效果方面具有很大价值。因此，CAD/CAM患者特异性切割导板和钢板是导板技术的一种有用替代方法。
