Holkom Mohammed, Sakran Karim A, Zhao Hui, Mohammed Abdo A S, Chen Xu, Mohammed Edres A, Liu Ke, Shang Zhengjun
State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
Department Oral and Maxillofacial-Head and Neck Oncology, School of Stomatology-Hospital of Stomatology, Wuhan University, Wuhan, China.
Head Neck. 2025 Feb;47(2):429-436. doi: 10.1002/hed.27918. Epub 2024 Aug 22.
This study investigates the unsatisfactory outcomes observed in mandibular reconstruction procedures attributed to improper condylar positioning in the Temporomandibular Joint. It also proposes a systematic classification for post-reconstruction condylar positioning dissatisfaction.
A retrospective analysis was conducted on 337 patients who underwent tumor removal and mandibular reconstruction with vascularized osteocutaneous flaps. Reconstruction techniques included conventional surgery (43.3%) and 3D technology-guided procedures (56.7%). Evaluation utilized preoperative and postoperative CT scans to assess mandibular vertical ramus length (V) and condylar alignment in both sagittal (S) and coronal (C) planes. Accordingly, a classification system for condylar positioning was developed and abbreviated as VSC. It includes four classes: Class I, proper condylar reconstruction; Class II, short ramus length; Class III, one or two aspects of sagittal/coronal condylar positions dissatisfaction; and Class IV, two or three aspects dissatisfaction.
The overall success rate for condylar reconstruction was 85.16%. Though not statistically significant, the success rate was marginally higher in the 3D-assisted group (85.86%) compared to the conventional group (84.25%). In terms of the VSC classification, the distribution of cases across Class I, II, III, and IV were 287, 4, 9, and 37 cases, respectively. Notably, condylar dislocation was significantly associated with the defect site, particularly the body and condyle (p < 0.001, OR = 49.734, 95% CI 12.995-190.342), and the number of reconstructed segments (p = 0.025, OR = 3.480, 95% CI 1.173-10.328).
The findings highlight the importance of accurate reconstruction methods and reveal implications of the defect site and the number of reconstructed segments in condylar dislocation. Consequently, we propose a classification system to refine condylar positioning assessment and enhance surgical outcomes in mandibular reconstruction.
本研究调查了颞下颌关节髁突定位不当导致下颌骨重建手术效果不理想的情况。同时，还提出了一种用于重建后髁突定位不满意情况的系统分类方法。
对337例行肿瘤切除及带血管蒂骨皮瓣下颌骨重建术的患者进行回顾性分析。重建技术包括传统手术（43.3%）和3D技术引导手术（56.7%）。评估利用术前和术后CT扫描来评估下颌垂直支长度（V）以及矢状面（S）和冠状面（C）上的髁突对线情况。据此，开发了一种髁突定位分类系统，并简称为VSC。它包括四类：I类，髁突重建合适；II类，支长度短；III类，矢状面/冠状面髁突位置有一个或两个方面不满意；IV类，有两个或三个方面不满意。
髁突重建的总体成功率为85.16%。虽然无统计学意义，但3D辅助组的成功率（85.86%）略高于传统组（84.25%）。根据VSC分类，I、II、III和IV类病例的分布分别为287例、4例、9例和37例。值得注意的是，髁突脱位与缺损部位显著相关，尤其是下颌体和髁突（p<0.001, OR = 49.734, 95% CI 12.995 - 190.342），以及重建节段的数量（p = 0.025, OR = 3.480, 95% CI 1.173 - 10.328）。
研究结果凸显了精确重建方法的重要性，并揭示了缺损部位和重建节段数量对髁突脱位的影响。因此，我们提出一种分类系统，以完善髁突定位评估并提高下颌骨重建的手术效果。
