CAD/CAM应用于健侧下颌角截骨及预成型钛网联合移植整复半侧颜面短小

doi:10.13591/j.cnki.kqyx.2023.01.013

摘要/Abstract

摘要： 目的探讨计算机辅助设计及制作(CAD/CAM)技术应用于预成型钛网及健侧下颌角移植整复成人半侧颜面短小畸形(HFM)的适应证及临床效果。方法纳入2013—2021年成人轻型半侧颜面短小畸形患者11例,术中切取对侧肥大下颌角联合预制个性化钛网植入患侧下颌骨。测量比较患者术前后患侧与健侧下颌体及下颌支的长度及三维角度、不对称指数,并结合面相照、术后并发症评估其治疗效果。结果所有患者术后面型明显改善,对手术效果满意,且无明显不良并发症。术后三维测量结果显示:除双侧下颌升支高度存在轻微不对称,术后患者下颌骨对称性良好(P>0.05);不对称指数由术前(17.11±4.56)%改善至术后(4.81±1.73)%(P=0.002)。结论该技术适用于健侧下颌角肥大的轻型半侧颜面短小畸形,可获得较满意的美学及临床效果。

关键词: 半侧颜面短小畸形, 骨增量, 预成型钛网, 计算机辅助设计及制作, 下颌角移植

Abstract: Objective To explore the indications and clinical effects of simultaneous mandibular angleplasty on the unaffected side, performed using preformed titanium mesh combined with mandibular angle bone graft, for the treatment of hemifacial microsomia (HFM). Methods The study group included 11 patients between 2013 and 2021 with HFM who underwent simultaneous mandibular angle reduction of the unaffected side and augmentation of the affected side using resected bone scaffolds within the titanium mesh. A series of mandibular linear measurements such as ramus height(RH)and mandibular body length(BL), angular measurements, and asymmetry index combined with clinical photographs and postoperative complications were used to assess the therapeutic effect. Results Postoperatively, all patients were satisfied. Significant improvement in mandibular contour was shown, with no obvious complications. Postoperative data, such as BL and angular measurements, showed no statistically significant differences(P>0.05) between the affected and unaffected sides with improvement in symmetry, except for RH(P<0.05). The preoperative and postoperative asymmetry index were (17.11±4.56)% and (4.81±1.73)%, respectively, with significant improvement(P=0.002). Conclusion This approach provides satisfactory results and significantly improves facial asymmetries for unilateral HFM with hypertrophy of the contralateral mandibular angle.

Key words: hemifacial microsomia, bone augmentation, preformed titanium mesh, CAD/CAM, mandibularangle bone graft

中图分类号:

R782.23

宋丽斌,Mohammed Qasem AlWatary,何映酉,毕丹丹,李继华. CAD/CAM应用于健侧下颌角截骨及预成型钛网联合移植整复半侧颜面短小[J]. 口腔医学, 2023, 43(1): 75-81.

SONG Libin,Mohammed Qasem AlWatary,HE Yingyou,BI Dandan,LI Jihua. Correction of hemifacial microsomia using preformed titanium mesh combined with contralateral mandibular angle bone graft with CAD/CAM assistance[J]. Stomatology, 2023, 43(1): 75-81.

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测量指标		术前						术后
测量指标		患侧		健侧		P		患侧		健侧		P
RH/mm	36.90±2.30		52.12±5.77		0.002^*		42.38±3.92		46.66±4.15		0.003^*
RH-MSP/(°)	10.98±3.52		18.02±3.99		0.024^*		12.02±8.19		15.37±3.30		0.441
RH-FHP/(°)	65.46±7.09		76.13±5.77		0.010^*		69.71±8.34		68.99±5.31		0.726
RH-FP/(°)	13.56±12.21		5.32±3.65		0.146		15.60±8.93		12.09±6.46		0.427
BL/mm	73.96±7.88		84.52±5.39		0.007^*		86.96±4.44		87.34±5.26		0.599
BL-MSP/(°)	31.65±2.81		41.44±5.26		0.003^*		38.50±2.80		35.28±3.94		0.128
BL-FHP/(°)	28.78±6.62		20.54±7.95		0.176		25.59±9.77		26.60±6.75		0.771
BL-FP/(°)	33.07±11.00		39.54±10.84		0.013^*		42.16±9.30		41.21±6.03		0.752

测量指标	术前	术后	P
BL/mm	10.56±4.55	1.14±0.88	0.009^*
RH/mm	14.56±6.01	4.28±1.47	0.014^*
BL-FHP/(°)	11.67±6.53	5.26±4.42	0.040^*
BL-FP/(°)	6.47±3.41	2.78±3.15	0.125
BL-MSP/(°)	9.79±3.34	3.25±3.69	0.024^*
RH-FHP/(°)	10.12±5.52	2.32±1.59	0.042^*
RH-FP/(°)	8.24±10.22	8.33±2.78	0.984
RH-MSP/(°)	6.61±3.93	3.17±1.94	0.034^*