Ha Sung-Ho, Maeng Ji Youn, Baek Seung-Hak, Choi Jin-Young
Departments of Oral and Maxillofacial Surgery.
Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea.
J Craniofac Surg. 2022 Oct 1;33(7):2172-2177. doi: 10.1097/SCS.0000000000008757. Epub 2022 Aug 17.
After Le Fort I osteotomy was first performed by von Langernbeck in 1859, there has been many improvements since. Research on and development of Le Fort I osteotomy procedure has shown downward movement of the maxilla to exhibit lowest stability and accuracy. However, maxillary downgraft movement is necessary in orthognathic patients with insufficient vertical length of the maxilla, but fixation of the maxilla after elongation is often very inaccurate. In this study, the authors utilized 3D virtual surgery, CAD/CAM-assisted 3D printing technology to overcome such limitations of maxillary total elongation. In addition, accuracy at 7 different landmarks from superimposition of virtual simulation data and postoperative Cone-beam computed tomography (CBCT) data were measured. Although posterior maxilla exhibited bigger range of errors, an error of <1 mm was measured at all 7 landmarks. Operation time was greatly shortened with cutting guides and customized plates. Although this study is a single-case study, this study shows increased accuracy and efficacy from application of 3D virtual surgery, CAD/CAM, and 3D printing technology.
1859年冯·朗根贝克首次进行勒福Ⅰ型截骨术以来，该技术有了许多改进。对勒福Ⅰ型截骨术的研究与发展表明，上颌骨向下移动时稳定性和准确性最低。然而，对于上颌骨垂直长度不足的正颌患者，上颌骨向下植骨移动是必要的，但延长后的上颌骨固定往往非常不准确。在本研究中，作者利用三维虚拟手术、计算机辅助设计/计算机辅助制造（CAD/CAM）辅助的三维打印技术来克服上颌骨整体延长的此类局限性。此外，还测量了虚拟模拟数据与术后锥形束计算机断层扫描（CBCT）数据叠加后7个不同标志点的准确性。尽管上颌骨后部的误差范围较大，但所有7个标志点的误差均<1毫米。使用切割导板和定制钢板大大缩短了手术时间。尽管本研究是一项单病例研究，但该研究表明应用三维虚拟手术、CAD/CAM和三维打印技术可提高准确性和疗效。
