Udayakumar Santhiya Iswarya Vinothini, Kim Dohyoung, Choi So-Young, Kwon Tae-Geon
Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-Daero, Jung-Gu, Daegu, 41940, Republic of Korea.
Maxillofac Plast Reconstr Surg. 2023 Sep 18;45(1):32. doi: 10.1186/s40902-023-00400-x.
The purpose of this study was to evaluate the pattern of predicted interosseous interference and to determine the influencing factor to volume of bony interference using a computer-assisted simulation system. This retrospective study recruited 116 patients with mandibular prognathism who had undergone sagittal split ramus osteotomy (SSRO) with or without maxillary osteotomy. The patients were divided into 3 groups according to the amount of menton (Me) deviation: less than 2 mm (Group 1), 2-4 mm (Group 2), and more than 4 mm (Group 3). Changes in the distal segments following BSSRO and the volume of the interosseous interference between the proximal and distal segments were simulated after matching preoperative occlusion and postoperative expected occlusion with the cone-beam computed tomography data. Ramal inclinations and other skeletal measurements were analyzed before surgery, immediately after surgery, and at least 6 months after surgery.
The anticipated interosseous interference was more frequently noted on the contralateral side of chin deviation (long side) than the deviated site (short side) in Groups 2 and 3. More interference volume was predicted at the long side (186 ± 343.9 mm) rather than the short side (54.4 ± 124.4 mm) in Group 3 (p = 0.033). The bilateral difference in the volume of the interosseous interference of the osteotomized mandible was significantly correlated with the Me deviation (r = - 0.257, p = 0.009) and bilateral ramal inclination (r = 0.361, p < 0.001). The predictor variable that affected the volume of the osseous interference at each side was the amount of Me deviation (p = 0.010).
By using the 3D simulation system, the potential site of bony collision could be visualized and successfully reduced intraoperatively. Since the osseous interference can be existed on any side, unilaterally or bilaterally, 3D surgical simulation is necessary before surgery to predict the osseous interference and improve the ramal inclination.
本研究旨在使用计算机辅助模拟系统评估预测的骨间干扰模式，并确定影响骨干扰体积的因素。这项回顾性研究纳入了116例接受了下颌升支矢状劈开截骨术（SSRO）（有或无上颌截骨术）的下颌前突患者。根据颏点（Me）偏移量将患者分为3组：小于2mm（第1组）、2 - 4mm（第2组）和大于4mm（第3组）。将术前咬合和术后预期咬合与锥形束计算机断层扫描数据匹配后，模拟双侧下颌升支矢状劈开截骨术后远心骨段的变化以及近心段和远心段之间的骨间干扰体积。在手术前、手术后即刻以及手术后至少6个月分析升支倾斜度和其他骨骼测量数据。
在第2组和第3组中，预期的骨间干扰在颏部偏移的对侧（长边）比偏移侧（短边）更常见。第3组中，预测在长边（186±343.9mm）的干扰体积大于短边（54.4±124.4mm）（p = 0.033）。截骨下颌骨骨间干扰体积的双侧差异与Me偏移（r = -0.257，p = 0.009）和双侧升支倾斜度（r = 0.361，p < 0.001）显著相关。影响每侧骨干扰体积的预测变量是Me偏移量（p = 0.010）。
通过使用三维模拟系统，可以可视化潜在的骨碰撞部位并在术中成功减少。由于骨干扰可单侧或双侧存在于任何一侧，因此手术前进行三维手术模拟对于预测骨干扰和改善升支倾斜度是必要的。
