Department of Orthodontics, Stomatology Hospital of Guangzhou Medical University, 59th Huangsha Road, Guangzhou, Guangdong, 510120, China.
Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107th Yanjiang Xi Road, Guangzhou, Guangdong, 510120, China.
BMC Oral Health. 2024 Apr 15;24(1):452. doi: 10.1186/s12903-024-04203-y.
To compare the changes in condylar position after mandibular reconstruction with free fibular flap(FFF) and the differences between computer-assisted techniques and traditional methods on CT images.
Thirty-four patients who underwent mandibular reconstruction with free fibular flap were selected according to the inclusion and exclusion criteria. In the 3D group, virtual surgical planning (VSP) with osteotomy cutting plate and placement guiding plate were used, while the traditional group underwent freehand reconstruction. The CT data of 68 temporomandibular joints (TMJs) were recorded before and immediately after surgery. The condylar position was evaluated by measuring the anterior space (AS), posterior space (PS) and superior space (SS), and the ln (PS/AS) was calculated according to the method proposed by Pullinger and Hollender.
In the patients included in the 3D group, the condyle on the ipsilateral side moved slightly backward; however, in the patients in the traditional group, the ipsilateral side moved considerably anteroinferior. No obvious changes on the contralateral side were noted. In the 3D group, 33% of ipsilateral condyles were in the posterior position postoperatively when compared with the preoperative position (13%). In the traditional group, the number of ipsilateral condyles in the anterior position increased from 4 to 10, accounting for 53% postoperatively. Contrary to the traditional group, the 3D group presented less condylar displacement on the ipsilateral side postoperatively.
This study showed a decreased percentage of change in condylar position postoperatively when VSP was used. Virtual surgical planning improved the accuracy of FFF mandibular reconstruction and made the condylar position more stable.
比较游离腓骨瓣（FFF）下颌骨重建后髁突位置的变化，以及计算机辅助技术与传统方法在 CT 图像上的差异。
根据纳入和排除标准，选择 34 例行游离腓骨瓣下颌骨重建的患者。在 3D 组中，使用带有截骨导板和放置导板的虚拟手术规划（VSP），而传统组则行徒手重建。记录 68 个颞下颌关节（TMJ）术前和术后即刻的 CT 数据。通过测量前间隙（AS）、后间隙（PS）和上间隙（SS）评估髁突位置，并根据 Pullinger 和 Hollender 提出的方法计算 PS/AS 的自然对数值。
在 3D 组患者中，患侧髁突轻微向后移动；而在传统组患者中，患侧髁突明显向前下移动。对侧无明显变化。在 3D 组中，术后同侧髁突有 33%处于术后位置，而术前位置为 13%。在传统组中，术前有 4 个髁突处于前位，术后增加到 10 个，占 53%。与传统组相反，3D 组术后同侧髁突移位较少。
本研究显示 VSP 可减少术后髁突位置的变化百分比。虚拟手术规划提高了游离腓骨瓣下颌骨重建的准确性，使髁突位置更稳定。
