Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Anderson Stuart Building, Camperdown, NSW 2006, Australia.
Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia.
J Plast Reconstr Aesthet Surg. 2024 Oct;97:50-58. doi: 10.1016/j.bjps.2024.07.061. Epub 2024 Jul 26.
Occlusal-based virtual surgical planning (VSP) prioritises the placement of endosseous dental implants, over replicating native bone contour. This may compromise facial aesthetics. This study aimed to compare function and health-related quality of life (HRQOL) following maxillomandibular reconstruction according to the ability to replicate preoperative soft-tissue contour and virtual plan.
Patients who underwent occlusal based VSP osseous free flap reconstruction of the maxilla or mandible with high-resolution pre- and post-operative facial computerised tomography imaging and completed the FACE-Q questionnaire were retrospectively identified. Accuracy of reconstruction compared to preoperative soft tissue contour and virtual plan, was measured using 3DSlicer® and CloudCompare® in three dimensions. Random effects modelling determined the associations between bony and soft tissue accuracy and HRQOL/functional domains.
Twenty-two patients met the inclusion criteria. For mandibular and maxillary reconstructions, better soft tissue accuracy was associated with improved appearance (p = 0.048) and appearance distress (p = 0.034). For mandibular reconstructions, better soft tissue accuracy was associated with improved smile (p = 0.039) and smile distress (p = 0.031). For maxillary reconstructions, better bony accuracy was associated with improved appearance (p = 0.023) and drooling distress (p = 0.001). Unexpectedly, better bony accuracy was associated with worse eating and drinking (p = 0.015), oral competence (p = 0.005) and eating distress (p = 0.013) in mandibular reconstructions.
Whilst soft tissue accuracy was associated with better functional and HRQOL outcomes, bone accuracy was associated with worse oral function or distress in mandibular reconstruction. These results require validation but should be considered when performing occlusal-based VSP, which prioritises dental rehabilitation over replicating facial bony contour.
基于咬合的虚拟手术规划（VSP）优先考虑种植体的植入位置，而不是复制原生骨轮廓。这可能会影响面部美观。本研究旨在比较根据复制术前软组织轮廓和虚拟计划的能力，对接受基于咬合的 VSP 骨游离皮瓣上颌或下颌重建患者的功能和健康相关生活质量（HRQOL）。
回顾性分析了接受基于咬合的 VSP 骨游离皮瓣上颌或下颌重建，且具有高分辨率术前和术后面部计算机断层扫描成像，并完成了 FACE-Q 问卷的患者。使用 3DSlicer®和 CloudCompare®在三维空间中测量重建与术前软组织轮廓和虚拟计划的准确性。随机效应模型确定了骨和软组织准确性与 HRQOL/功能域之间的关联。
22 例患者符合纳入标准。对于下颌和上颌重建，更好的软组织准确性与改善的外观（p=0.048）和外观困扰（p=0.034）相关。对于下颌重建，更好的软组织准确性与改善的笑容（p=0.039）和笑容困扰（p=0.031）相关。对于上颌重建，更好的骨准确性与改善的外观（p=0.023）和流涎困扰（p=0.001）相关。出乎意料的是，更好的骨准确性与下颌重建中较差的进食和饮水（p=0.015）、口腔功能（p=0.005）和进食困扰（p=0.013）相关。
尽管软组织准确性与更好的功能和 HRQOL 结果相关，但骨准确性与下颌重建中较差的口腔功能或困扰相关。这些结果需要验证，但在进行优先考虑牙齿修复而不是复制面部骨轮廓的基于咬合的 VSP 时应予以考虑。
