Oral and Maxillofacial Surgery Resident, University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil.
Oral and Maxillofacial Surgery Resident, University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil.
J Oral Maxillofac Surg. 2021 Apr;79(4):892.e1-892.e7. doi: 10.1016/j.joms.2020.11.011. Epub 2020 Nov 22.
In severe atrophic mandibular fractures, the absence of stable occlusion, as well as poor bone volume at the fracture site, constitutes a lack of references during surgery to achieve accurate fracture reduction. Unsuccessful reduction and stabilization can lead to several complications, such as fracture misalignments, malunion, and facial asymmetry. An alternative to avoid the aforementioned issues is fracture reduction based on virtual surgical planning (VSP) technology. However, there is little information regarding VSP protocols for the management of mandible fractures. Herein, a new technique with low cost is reported in which VSP and computer-aided manufacturing of a positioning guide were applied in a 72-year-old female patient with bilateral fractures in her atrophic mandible in the body region. The positioning guide was used during fracture reduction on the inferior surface of the mandible as per the virtual reduction. A 3-dimensional mandible model was also printed, facilitating the prebent 2.4-mm reconstructive plate. The surgical procedure was performed with no complications, resulting in the accurate fit of both the bent plate and the guide. A postoperative computed tomography scan showed good condylar position, fracture reduction, and hardware adaptation. A follow-up approximately 2 years later showed that she was successfully rehabilitated with the dental prosthesis. Therefore, VSP is a valuable tool for attaining a predictable result in the treatment of severe atrophic mandibular fracture, with a reduced operative duration, acceptable precision of fracture reduction, and low cost.
在严重的下颌骨萎缩性骨折中，由于缺乏稳定的咬合关系以及骨折部位骨量不足，这给手术中实现准确骨折复位带来了困难。复位和固定不成功可能导致多种并发症，如骨折错位、愈合不良和面部不对称。为避免上述问题，可以采用基于虚拟手术规划（VSP）技术的骨折复位方法。然而，关于 VSP 技术在治疗下颌骨骨折方面的应用，目前相关信息较少。在此，我们报道了一种新的低成本技术，该技术将 VSP 和计算机辅助制造的定位导板应用于一名 72 岁女性双侧下颌体萎缩性骨折患者。该定位导板用于根据虚拟复位对下颌骨的下表面进行骨折复位。还打印了一个 3D 下颌骨模型，以便预弯 2.4 毫米重建板。手术过程顺利，没有出现并发症，因此弯曲的钢板和导板都能精确适配。术后 CT 扫描显示髁突位置良好，骨折复位和内固定适应良好。大约 2 年后的随访显示，她成功地通过义齿修复进行了康复。因此，VSP 是治疗严重下颌骨萎缩性骨折的一种有价值的工具，可以缩短手术时间，提高骨折复位的精度，降低成本，获得可预测的治疗效果。
