Koenig Zachary A, Lokant Bradley T, Weaver Samantha, Brooke Sebastian M, Uygur Halil S
West Virginia University Division of Plastic, Reconstructive, & Hand Surgery.
West Virginia University School of Medicine, Morgantown, WV.
J Craniofac Surg. 2024;35(2):649-651. doi: 10.1097/SCS.0000000000009898. Epub 2023 Nov 16.
In cases of significantly displaced or comminuted mandible fractures, surgical guide splints can be developed to create the normal preinjury occlusion rather than placing patients in maxillomandibular fixation. Standard fracture fixation involves bending of plates intraoperatively based on surgeon-constructed dental splints which is prone to error.
A 38-year-old male experienced a gunshot wound to the face that resulted in mandibular angle fractures bilaterally causing severely deranged occlusion and free-floating anterior mandible segment. Virtual surgical planning (VSP) software was used to recreate the injury-induced anatomy and anticipated postoperative anatomy. It also provided a surgical guide splint and a framework to preoperatively bend reconstruction plates to assist in achieving proper occlusion.
He underwent open reduction internal fixation of comminuted mandible fractures with lingual guide splint placement 10 days after injury. Following lingual splint application, the reconstruction plate was applied from angle to angle. The lingual splint was maintained for 3 weeks postoperatively to support the stabilization, and he was able to tolerate a regular diet and showed no evidence of wound breakdown.
Virtual surgical planning has had important implications in craniofacial surgery, orthognathic surgery, maxillomandibular reconstruction, and orbital reconstruction after tumor resection, temporomandibular joint surgery, and others. However, there have only been isolated reports describing the role of VSP in the facial trauma setting. In this technical study, the authors demonstrate the benefits of VSP and surgical guide splinting in trauma settings.
在严重移位或粉碎性下颌骨骨折的病例中，可以制作手术导板夹板以恢复伤前的正常咬合关系，而不是让患者进行颌间固定。标准的骨折固定需要在术中根据外科医生制作的牙夹板弯曲钢板，这容易出错。
一名38岁男性面部遭受枪伤，导致双侧下颌角骨折，造成严重的咬合紊乱和下颌前部游离浮动。使用虚拟手术规划（VSP）软件重建损伤导致的解剖结构和预期的术后解剖结构。它还提供了一个手术导板夹板和一个框架，用于术前弯曲重建钢板，以协助实现正确的咬合。
受伤10天后，他接受了粉碎性下颌骨骨折切开复位内固定术，并放置了舌侧导板夹板。应用舌侧夹板后，从一个角到另一个角应用重建钢板。术后保留舌侧夹板3周以支持稳定，他能够耐受正常饮食，且伤口无裂开迹象。
虚拟手术规划在颅面外科、正颌外科、颌骨重建、肿瘤切除后的眼眶重建、颞下颌关节手术等方面具有重要意义。然而，仅有个别报道描述了VSP在面部创伤中的作用。在这项技术研究中，作者展示了VSP和手术导板夹板在创伤情况下的益处。
