髁突良性病变继发偏颌畸形手术治疗顺序研究

Study of the best surgical sequence for condylar benign lesions with facial asymmetries

目的 探讨髁突良性病变继发偏颌畸形的最佳手术治疗顺序.方法 收集2014年5-9月在上海交通大学医学院附属第九人民医院口腔外科收治的6例单侧髁突良性病变继发偏颌畸形患者的CT资料,采用ProPlanCMF1.4软件分别模拟2种手术顺序：（1）先行上颌骨Le Fort Ⅰ型截骨,再行髁突高位切除＋下颌骨矢状劈开截骨术（BSSRO）;（2）先行髁突高位切除＋BSSRO后,再行上颌骨Le Fort Ⅰ型截骨.比较两种不同手术顺序中间（牙合）板的厚度及宽度.结果 6例患者中,5例露齿正常（露齿2.0 ～ 3.0 mm）的患者,手术顺序（2）比（1）的中间（牙合）板厚度和宽度显著减小,其中厚度平均薄3.99 mm,宽度平均窄2.47 mm,差异均有统计学意义（均P＜0.05）：1例露齿过多（露齿5.5 mm）的患者,上颌骨需要整体压缩抬高,手术顺序（1）比（2）的中间（牙合）板体积小,厚度薄3.09 mm,宽度窄1.99 mm.结论 髁突良性病变继发偏颌畸形的关节颌骨同期手术中,在露齿正常的情况下,采用先髁突高位切除＋BSSRO再行上颌骨Le Fort Ⅰ型截骨的手术顺序比先行上颌骨Le Fort Ⅰ型截骨再髁突高位切除＋BSSRO的手术顺序更准确.

Objective To study the best surgical sequence for condylar benign lesions with facial asymmetries. Meth-ods CT data of all patients who were diagnosed with unilateral condylar benign lesions with facial asymmetries treatedin our department were included in the study. ProPlan CMF 1.4 software was used to simulate the two different surgicalsequences respectively： （1）Le Fort I osteotomy first, and then high eondylcetomy ＋ BSSRO（MaxF） ; （2）Condyletomy＋ BSSRO first, and then Le Fort I osteotomy （ManF）. Interim splint was designed and measured virtually to comparethe thickness and width between the two surgical sequences. Results ManF had significant thinner （mean 3.99mm）and narrower （mean 2.47mm） interim splint than MaxF in 5 patients without maxillary middle incisor height change（allP 〈 0.05）. But in 1 patient with maxillary impaction, MaxF had 3.09 mm thinner and 1.99 mm narrower interim splintthan ManF. Conclusion ManF is better than MaxF in patients without maxillary middle incisor height change in the si-multaneous treatment for unilateral condylar benign lesions with facial asymmetries.