利用数字外科技术辅助矫正偏颌畸形

Application of digital plastic surgery in the treatment of jaw deformity

背景:偏颌畸形涉及到的解剖部位较多,修复较复杂,同时由于此类疾病的治疗方法没有标准化的手术模式,患者的畸形类型也有很大差别,所以此类手术的设计和实施主要依靠医生的经验,会有许多不尽人意之处。目的:探讨利用数字外科技术制作仿真头颅模型,用来辅助手术设计和矫正偏颌畸形的方法。方法:针对1例上、下颌骨外伤性偏颌畸形患者,采用CT扫描和三维重建,应用快速成型技术,制作患者颅面部骨组织三维模型,在此模型上设计手术方案。为保持目前咬合关系,将上颌骨下份和下颌骨整体逆时针旋转5°,左侧下颌支去除部分骨质,将颏部左移至中线。模拟手术过程:在三维头颅模型上进行截骨、移位等操作,观察矫治效果。在三维头颅模型上制作必要的辅助工具,用来指导手术并提高矫治的精确性。结果与结论:患者矫治后对面部外形效果满意,咬合关系、咀嚼功能均未受到影响。提示数字外科技术能真实再现畸形颌骨的形态,为准确诊断、设计矫治方案、模拟矫治过程、指导手术进行提供理想的外科模型,对偏颌畸形的矫正有很好的辅助作用。

BACKGROUND： Plenty of anatomic sites are involved in jaw deformity, which need to be repaired from solid structures. However, the treating outcomes are unsatisfactory due to lack of standardized surgery modes and the distinction of each patient. OBJECTIVE： To explore the use of digital simulation skull model for designing and correcting asymmetrical deformity of jaws. METHODS： For a case with traumatic jaw deformity, CT scan and three-dimensional reconstruction were performed. Then rapid prototyping technique was used to produce the craniofacial skull model of the patient. In order to maintain the occluding relation, lower portion of maxilla and the whole mandible were counterclockwise rotated 5°, parts of sclerotin were removed from left mandible, and the mental region was left moved to the midline. Surgical procedures were simulated on the model and necessary supporting tools were prefabricated according to it, which also guided surgery and improved the accuracy of surgery. RESULTS AND CONCLUSION： The patient was satisfied with normal facial appearance, occlusion plane, and masticatory function after operation. The form of asymmetrical deformity of jaws can be truly reproduced by rapid prototyping and simulating operation process with the aid of digital plastic surgery, which provides strong basis for accurate diagnosis, reasonable surgical plans, and good result.