Fellow, Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Fellow, Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.
Fellow, Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Resident, Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy; and International Scholar, Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.
J Oral Maxillofac Surg. 2021 Jun;79(6):1345-1354. doi: 10.1016/j.joms.2020.12.031. Epub 2020 Dec 29.
The purpose of this study was to determine which of the most commonly used flaps restore contour more accurately in mandibular body reconstructions using conformance analyses and virtual measurements.
Using normal computed tomography (CT) scans and a 3D software, mandibular body defects were virtually created. "Single shot" and osteotomized fibula flaps (SS-FF and O-FF), iliac crest flaps (ICF) and scapular tip flaps (STF) were digitally harvested and coregistered to reconstruct those defects. Conformance analyses were performed by calculating the root mean square (RMS) for overall and contour conformance.
Ten patients normal CT scans were included. The STF demonstrated improved overall conformance compared with the ICF, the SS-FF and the O-FF (RMS = 2.03 mm vs 4.53 mm vs 2.76 vs 2.37 mm, respectively; p<.001). Similar trends were seen for contour conformance in STF compared with the ICF and the SS-FF (RMS = 2.48 mm vs 4.50 mm vs 3.28 mm, respectively), whereas the O-FF performed better than STF (RMS = 1.85 mm vs 2.48 mm; p<.001).
The osseous component of the STF resembles the mandibular body more accurately than the one in the ICF and FF without the need for an osteotomy. Future clinical studies can help to elucidate the clinical impact of these virtual findings.
本研究旨在通过一致性分析和虚拟测量，确定在进行下颌骨体重建时，最常用的哪种皮瓣能更准确地恢复轮廓。
使用正常的计算机断层扫描（CT）和三维软件，虚拟创建下颌骨体缺损。“单次切割”和截骨腓骨皮瓣（SS-FF 和 O-FF）、髂嵴皮瓣（ICF）和肩胛骨尖端皮瓣（STF）被数字化采集并进行配准以重建这些缺陷。通过计算整体和轮廓一致性的均方根（RMS）来进行一致性分析。
纳入了 10 例正常 CT 扫描患者。STF 与 ICF、SS-FF 和 O-FF 相比，整体一致性得到改善（RMS=2.03mm 比 4.53mm 比 2.76mm 比 2.37mm，分别；p<.001）。在轮廓一致性方面，STF 与 ICF 和 SS-FF 相比也呈现出类似的趋势（RMS=2.48mm 比 4.50mm 比 3.28mm，分别），而 O-FF 则比 STF 表现更好（RMS=1.85mm 比 2.48mm；p<.001）。
STF 的骨性成分比 ICF 和 FF 更准确地模仿下颌骨体，而无需进行骨切开术。未来的临床研究可以帮助阐明这些虚拟发现的临床影响。
