Peninsula Oral Surgery San Jose, San Jose, CA; College of Dental Medicine, Western University of Health Sciences, Pomona, CA, USA; Department of Oral and Maxillofacial Surgery, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, CA, USA.
Division of Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Perm J. 2022 Apr 5;26(1):137-142. doi: 10.7812/TPP/21.054.
Patient-specific implants (PSIs) are accurate, efficient alternatives to traditional plate fixation. They are well-suited for use in procedures that require the utmost accuracy, stability, and efficiency. Although PSIs have demonstrated such qualities in craniomaxillofacial reconstruction, they have so far found limited utilization elsewhere.
We explored the departmental protocol for Lefort 1 PSI orthognathic surgery at a high-volume, tertiary referral center. Three cases were selected that matched predetermined criteria, which included treatment by the same surgical team, concurrent Lefort 1 osteotomy and bilateral sagittal split osteotomy, Angle's type 3 malocclusion, lack of interdental osteotomies, and American Society of Anesthesiologists classification 2 or less without metabolic or osseous diseases. The operative outcomes from these patients were then compared to similar cases also meeting the same criteria and conducted within the same time period.
The use of PSI in Lefort 1 osteotomy is associated with anatomically sound designs that could contribute to postoperative stability of the jaws. They also have not shown increased rates of complications such as infection, dehiscence, or relapse at 6 weeks postoperatively but may in fact decrease the operative duration. These findings are consistent with the results gleaned from literature on the use of PSI in craniomaxillofacial reconstruction.
患者特定植入物(PSIs)是传统板固定的准确、高效替代品。它们非常适合需要最高精度、稳定性和效率的手术。尽管 PSIs 在颅面重建中表现出了这些特性,但它们在其他地方的应用仍然有限。
我们在一家高容量的三级转诊中心探讨了 Lefort 1 PSI 正颌手术的部门方案。选择了三个符合预定标准的病例,这些标准包括由同一手术团队治疗、同时进行 Lefort 1 切开术和双侧矢状劈开截骨术、Angle 类 3 错颌、无牙间切开术、美国麻醉医师协会分类 2 级或以下且无代谢或骨骼疾病。然后将这些患者的手术结果与同期也符合相同标准的类似病例进行比较。
Lefort 1 切开术中使用 PSI 与解剖结构合理的设计相关,这可能有助于术后颌骨的稳定性。它们在术后 6 周也没有显示出更高的感染、裂开或复发率,但实际上可能会缩短手术时间。这些发现与 PSI 在颅面重建中的应用文献中得出的结果一致。