Sugahara Keisuke, Koyachi Masahide, Odaka Kento, Matsunaga Satoru, Katakura Akira
Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kanda Misaki-cho, Chiyoda-ku, Tokyo, Japan.
Oral Health Science Center, Tokyo Dental College, 2-9-18 Kanda Misaki-cho, Chiyoda-ku, Tokyo, Japan.
Maxillofac Plast Reconstr Surg. 2020 Sep 11;42(1):32. doi: 10.1186/s40902-020-00276-1. eCollection 2020 Dec.
Le Fort I osteotomy is a highly effective treatment for skeletal jaw deformities and is commonly performed. High Le Fort I osteotomy is a modified surgical procedure performed for improving the depression of the cheeks by setting the osteotomy higher than the conventional Le Fort I osteotomy. Developments in three-dimensional (3D) technology have popularized the use of 3D printers in various institutions, especially in orthognathic surgeries. In this study, we report a safe and inexpensive method of performing a high Le Fort I osteotomy using a novel 3D device and piezosurgery, which prevent tooth root injury without disturbing the operation field for patients with a short midface and long tooth roots.
A 17-year-old woman presented with facial asymmetry, mandibular protrusion, a short midface, and long tooth roots. We planned high Le Fort I osteotomy and bilateral sagittal split ramus osteotomy. Prevention of damage to the roots of the teeth and the infraorbital nerve and accurate determination of the posterior osteotomy line were crucial for clinical success. Le Fort I osteotomy using 3D devices has been reported previously but were particularly large in size for this case. Additionally, setting the fixing screw of the device was difficult, because of the risk of damage to the roots of the teeth. Therefore, a different surgical technique, other than the conventional Le Fort I osteotomy and 3D device, was required. The left and right parts of the 3D device were fabricated separately, to prevent any interference in the surgical field. Further, the 3D device was designed to accurately cover the bone surface from the piriform aperture to the infra-zygomatic crest with two fixation points (the anterior nasal spine and the piriform aperture), which ensured stabilization of the 3D device. The device is thin and does not interfere with the surgical field. Safe and accurate surgical performance is possible using this device and piezosurgery. The roots of the teeth and the infraorbital nerve were unharmed during the surgery.
This device is considerably smaller than conventional devices and is a simple, low-cost, and efficient method for performing accurate high Le Fort I osteotomy.
勒福Ⅰ型截骨术是治疗颌骨骨骼畸形的一种高效手术，应用广泛。高位勒福Ⅰ型截骨术是一种改良手术，通过将截骨线设置得比传统勒福Ⅰ型截骨术更高，来改善脸颊凹陷。三维（3D）技术的发展使3D打印机在各类机构中得到普及，尤其是在正颌外科手术中。在本研究中，我们报告了一种使用新型3D设备和压电手术进行高位勒福Ⅰ型截骨术的安全且低成本的方法，该方法可防止牙根损伤，且不会干扰面中份短、牙根长患者的手术视野。
一名17岁女性，存在面部不对称、下颌前突、面中份短以及牙根长的问题。我们计划进行高位勒福Ⅰ型截骨术和双侧矢状劈开下颌支截骨术。防止牙齿牙根和眶下神经受损以及准确确定后方截骨线是临床成功的关键。此前已有使用3D设备进行勒福Ⅰ型截骨术的报道，但针对该病例的设备尺寸特别大。此外，由于存在损伤牙齿牙根的风险，该设备的固定螺钉难以设置。因此，需要一种不同于传统勒福Ⅰ型截骨术和3D设备的手术技术。3D设备的左右部分分开制作，以防止对手术视野产生任何干扰。此外，3D设备设计为通过两个固定点（前鼻棘和梨状孔）准确覆盖从梨状孔到颧下嵴的骨表面，从而确保3D设备的稳定性。该设备很薄，不会干扰手术视野。使用该设备和压电手术能够实现安全、准确的手术操作。手术过程中牙齿牙根和眶下神经未受损伤。
该设备比传统设备小得多，是一种进行准确高位勒福Ⅰ型截骨术的简单、低成本且高效的方法。
