面侧偏颌畸形的综合治疗方法：正颌外科与序贯定制化植入相结合。
Comprehensive treatment approach for hemifacial microsomia: Integrating orthognathic surgery with sequential customized implantation.
机构信息
Department of Oral and Caniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China.
Department of Oral and Caniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China.
出版信息
J Plast Reconstr Aesthet Surg. 2024 Dec;99:406-415. doi: 10.1016/j.bjps.2024.09.015. Epub 2024 Sep 7.
OBJECTIVE
This study aimed to evaluate the clinical outcomes of combining orthognathic surgery with staged patient-specific implants (PSIs) for comprehensive craniofacial asymmetry reconstruction in adult patients with hemifacial microsomia (HFM).
METHODS
Six adults with HFM (1 Type I and 5 Type IIa) underwent orthognathic surgery to correct skeletal malocclusion and chin deviation. Sequential PSIs were implanted to address craniofacial asymmetry. Digital lateral cephalograms and cranial computed tomography scans were obtained at four time points: pre-orthognathic surgery (T0), within three months after orthognathic surgery (T1), one year after orthognathic surgery and just before personalized implantation (T2), and after personalized implantation (T3). Evaluation parameters included skeletal and dentoalveolar measures, occlusal cant, chin deviation, skeletal stability, and facial contour symmetry.
RESULTS
At T1, no significant differences were observed in skeletal movements compared with planned surgical movements (p > 0.05). Similarly, at T2, skeletal movements did not significantly differ from those observed at T1 (p > 0.05), indicating surgical precision and stability. Analysis of skeletal and dentoalveolar parameters, occlusal cant, and chin deviation revealed significant increases in SNB, FH-NPo, and ST N vert-Pog at T1 compared to T0 (p < 0.05), along with notable improvements in chin deviation and occlusal cant (p < 0.05). Comparison of T2 to T1 showed no significant changes in SNB, FH-NPo, ST N vert-Pog, chin deviation, or occlusal cant (p > 0.05), indicating substantial postoperative stability. After personalized implantation (T3), further significant improvements were observed in skeletal symmetry.
CONCLUSION
Combining orthognathic surgery with staged PSIs effectively reconstructs craniofacial asymmetry in adult patients with HFM, achieving significant improvements in skeletal alignment, occlusal cant, and chin deviation, with stable outcomes over time.
目的
本研究旨在评估在成人半侧颜面短小畸形（HFM）患者中，通过正颌手术联合分期患者特异性植入物（PSI）治疗全面颅面不对称的临床效果。
方法
6 例 HFM 成人患者（1 例 I 型和 5 例 IIa 型）接受正颌手术以矫正骨骼咬合不正和颏部偏斜。随后分期植入 PSI 以解决颅面不对称问题。在 4 个时间点获得数字侧位头颅侧位片和颅部 CT 扫描：正颌手术前（T0）、正颌手术后 3 个月内（T1）、正颌手术后 1 年且在个性化植入前（T2）以及个性化植入后（T3）。评估参数包括骨骼和牙颌测量、咬合倾斜、颏部偏斜、骨骼稳定性和面部轮廓对称性。
结果
T1 时，与计划手术移动相比，骨骼移动没有显著差异（p＞0.05）。同样，T2 时，骨骼移动与 T1 时相比没有显著差异（p＞0.05），表明手术精度和稳定性。对骨骼和牙颌参数、咬合倾斜和颏部偏斜的分析显示，与 T0 相比，T1 时 SNB、FH-NPo 和 ST N vert-Pog 显著增加（p＜0.05），同时颏部偏斜和咬合倾斜明显改善（p＜0.05）。与 T1 相比，T2 时 SNB、FH-NPo、ST N vert-Pog、颏部偏斜和咬合倾斜没有显著变化（p＞0.05），表明术后稳定性较高。个性化植入后（T3），骨骼对称性进一步显著改善。
结论
在成人 HFM 患者中，正颌手术联合分期 PSI 可有效重建颅面不对称，在骨骼排列、咬合倾斜和颏部偏斜方面取得显著改善，且随着时间的推移具有稳定的效果。
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