Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Egypt.
J Craniomaxillofac Surg. 2022 Jun;50(6):504-514. doi: 10.1016/j.jcms.2022.04.002. Epub 2022 May 9.
The aim of the current study was to evaluate the effect of the use of computer-guided surgical templates in association with mandibular distraction osteogenesis to correct mandibular asymmetry. In the study group a simulation process was conducted to restore the exact position of the chin skeletally by planning the osteotomy orientation, distractor vector, pin positions, and distraction distance calculation. The Control group was treated with conventional distraction in which an oblique osteotomy was done, and distraction was performed until the midline coincided. Patients were randomly allocated into two groups, study and control. The study included (12) young patients; ten males participated and two females (average age 14 ± 6 years) (Range = 6-23 years)). There was a statistically significant (P = 0.02) improvement in smile orientation in the study with 63.7% ± 19% improvement compared to control, which had only 37% ± 14%. There was a statistically significant (P = 0.02) improvement in ramus height in the study with 93% ± 9% improvement compared to control, which had only 74% ± 16%. There was a non-significant (P = 0.2) improvement in chin deviation in the study with 42% ± 26% improvement compared to control, which had only 25% ± 15%. The secondary outcome results showed that there was statistically significant (P = 0.0001) improvement in smile orientation post distraction 50% ± 21%, there was statistically significant (P= P=0.002) improvement of ramus height post distraction osteogenesis 82% ± 16%, and there was statistically significant (P = 0.0001) improvement in chin deviation 33% ± 22% post distraction osteogenesis. Overall, the current research recommends the use of computer planned distraction instead of conventional planned distraction in order to achieve better symmetry. Distraction failed in correction of chin asymmetry; thus, the authors recommend performing genioplasty post distraction after the patient reaches puberty for more optimum results regarding the chin.
本研究旨在评估在使用下颌骨牵引成骨术矫正下颌骨不对称时使用计算机引导手术模板的效果。在研究组中，通过规划骨切开方向、牵引器向量、针位和牵引距离计算，进行了模拟过程，以恢复颏骨的精确骨骼位置。对照组采用传统的牵引方法，行斜形骨切开，直至中线重合。患者随机分为两组，研究组和对照组。研究组包括（12）名年轻患者；10 名男性和 2 名女性（平均年龄 14±6 岁）（范围 6-23 岁）。研究组的微笑方向有统计学意义的（P=0.02）改善，改善率为 63.7%±19%，而对照组仅为 37%±14%。研究组的升支高度有统计学意义的（P=0.02）改善，改善率为 93%±9%，而对照组仅为 74%±16%。研究组的颏部偏斜有统计学意义的（P=0.2）改善，改善率为 42%±26%，而对照组仅为 25%±15%。次要结果显示，牵引后 50%±21%的微笑方向有统计学意义的（P=0.0001）改善，牵引后 82%±16%的升支高度有统计学意义的（P=0.002）改善，牵引后 33%±22%的颏部偏斜有统计学意义的（P=0.0001）改善。总的来说，本研究建议使用计算机规划的牵引代替传统规划的牵引，以达到更好的对称性。牵引未能纠正颏部不对称；因此，作者建议在患者达到青春期后进行颏成形术，以获得更理想的颏部结果。
