Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
J Craniomaxillofac Surg. 2022 Jan;50(1):19-25. doi: 10.1016/j.jcms.2021.09.011. Epub 2021 Sep 29.
This retrospective case-series study aimed to elucidate the three-dimensional attachment morphometric features and to quantify the volumetric changes of the masticatory muscles following free fibular flap reconstruction of the mandibular condyle. Navigation software (iPlan, version 3.0; Brainlab) was used to perform delineation and volumetric measurement of the masticatory muscles using DICOM data. In total, 30 patients were included in this retrospective case series. In 25 cases (83.33%), the lateral pterygoid muscle achieved reattachment within 6 months postoperatively. The medial pterygoid muscles on the affected side achieved ectopic attachment in all cases. However, masseter reattachment on the affected side was achieved in only three cases. On the normal side, the volumes of lateral pterygoid muscle, medial pterygoid muscle, and masseter had recovered to almost preoperative levels at 1 year postoperatively. On the affected side, the volume of medial pterygoid muscle had decreased significantly (p = 2.4e-04) at 3 months postoperatively. The volumes of lateral pterygoid muscle and masseter showed mild decreases at 3 months postoperatively, but these were not significant (p = 0.52 and p = 0.05 for the pterygoid muscle and masseter, respectively). At 6 months after surgery, with the exception of the volume of the lateral pterygoid muscle (p = 0.06), the total volume of the masticatory muscles decreased significantly on the affected side. The volumes of lateral pterygoid muscle, medial pterygoid muscle, and masseter showed significant decreases at 1 year postoperatively (p = 0.03, p = 4.7e-08, and p = 1.1e-05, respectively) on the affected side. The postoperative volumes of the masseter, medial pterygoid, and lateral pterygoid muscles showed significant decreases due to the loss of reattachment. The results of this study may not help to ascertain whether reattachment of masticatory muscles will lead to better function. As a consequence, clinical trials of higher quality are needed.
本回顾性病例系列研究旨在阐明三维附着形态特征，并量化游离腓骨瓣重建下颌骨髁突后咀嚼肌的体积变化。使用导航软件（iPlan，版本 3.0；Brainlab），根据 DICOM 数据对咀嚼肌进行描绘和体积测量。共纳入 30 例患者。在 25 例（83.33%）患者中，术后 6 个月内，外侧翼肌实现了再附着。受影响侧的内侧翼肌在所有病例中均发生异位附着。然而，仅在 3 例患者的受影响侧实现了咬肌再附着。在正常侧，术后 1 年时，外侧翼肌、内侧翼肌和咬肌的体积几乎恢复到术前水平。术后 3 个月，患侧内侧翼肌的体积明显减少（p=2.4e-04）。术后 3 个月，外侧翼肌和咬肌的体积略有减少，但无统计学意义（外侧翼肌和咬肌的 p 值分别为 0.52 和 0.05）。术后 6 个月，除了外侧翼肌的体积（p=0.06）外，患侧咀嚼肌总体积明显减少。术后 1 年，患侧的外侧翼肌、内侧翼肌和咬肌体积明显减少（p=0.03、p=4.7e-08 和 p=1.1e-05）。由于丧失再附着，术后咬肌、内侧翼肌和外侧翼肌的体积减少。本研究的结果可能无助于确定咀嚼肌的再附着是否会导致更好的功能。因此，需要进行更高质量的临床试验。
