Department of Pediatric Maxillofacial Surgery and Craniofacial Surgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, Tours, France.
Department of Maxillofacial and Plastic Surgery, Trousseau Hospital, Tours University Hospital, Tours, France.
Facial Plast Surg Aesthet Med. 2020 Nov/Dec;22(6):433-440. doi: 10.1089/fpsam.2020.0129. Epub 2020 Jul 10.
Surgery of orbital hypertelorism (ORH) remains an imprecise surgical procedure depending on the experience and habits of the craniofacial surgical teams. Computer-assisted surgery (CAS) has developed dramatically in craniofacial surgery, but there is no current study assessing its accuracy for ORH surgery. This study aimed to assess the input of CAS and especially the accuracy of the cutting guide-based procedures. The authors presented the computer-assisted box osteotomy or facial bipartition techniques and compared the preoperative surgical planning with the postoperative results. A monocentric retrospective study included the patients who underwent surgical correction of ORH from 2016 to 2019 at the University Hospital Center of Tours, France. All the patients had a computer-assisted orbital hypertelorism surgery (CAOHS) using cutting guides and tailored fixation plates. Of 10 patients included, 7 were treated by box osteotomies and 3 by facial bipartitions. Each patient had a preoperative computed tomography (CT) scan enabling a virtual simulation of the reconstruction and the manufacturing of patient-specific cutting guides and customized osteosynthesis plates. The postoperative CT scans were compared with the three-dimensional (3D) virtual simulation using the distances between the sagittal plane and orbital and infraorbital reference points, and from the measurement of the orbital advancement (i.e., 10 reference measurements). All patients had satisfactory clinical and aesthetical outcomes with a mean interorbital distance of 22.8 ± 2.8 mm. The postoperative measurements were significantly higher than for the surgical planning ( < 0.0001). The average absolute differences between the 3D virtual planning and the postoperative CT scans were <1.30, 1.90, and 0.80 mm for the orbital, infraorbital, and orbital advancement measurements, respectively. The overall accuracy of the CAOHS (root mean square deviation) was 1.39 mm. The use of computer-assisted design and computer-aided manufacturing device, such as cutting guides and tailored plates, facilitates the bony surgical correction of ORH using box osteotomy or facial bipartition and allows for valuable, reproducible, and satisfactory clinical outcomes.
眼眶距增宽（ORH）的手术仍然是一种不精确的手术程序，这取决于颅面外科团队的经验和习惯。计算机辅助手术（CAS）在颅面外科中得到了迅猛发展，但目前尚无研究评估其在 ORH 手术中的准确性。本研究旨在评估 CAS 的输入，特别是基于切割导板的程序的准确性。作者提出了计算机辅助盒状截骨术或面部二分术，并比较了术前手术计划与术后结果。一项单中心回顾性研究纳入了 2016 年至 2019 年在法国图尔大学医院中心接受 ORH 手术矫正的患者。所有患者均接受了基于切割导板和定制固定板的计算机辅助眶距增宽手术（CAOHS）。10 例患者中，7 例行盒状截骨术，3 例行面部二分术。每位患者均进行了术前计算机断层扫描（CT）检查，以便对重建进行虚拟模拟，并制造患者特定的切割导板和定制的骨合成板。术后 CT 扫描与三维（3D）虚拟模拟进行比较，使用矢状面和眶及眶下参考点之间的距离，以及眶部推进的测量值（即 10 个参考测量值）。所有患者均获得了满意的临床和美容效果，平均眶距为 22.8±2.8mm。术后测量值明显高于手术计划（ <0.0001）。3D 虚拟规划与术后 CT 扫描之间的平均绝对差异分别为眶、眶下和眶部推进测量值的<1.30、1.90 和 0.80mm。CAOHS 的整体准确性（均方根偏差）为 1.39mm。使用计算机辅助设计和计算机辅助制造设备，如切割导板和定制板，有助于使用盒状截骨术或面部二分术进行骨性 ORH 矫正，并可获得有价值、可重复和满意的临床结果。
