计算机导航技术在下颌骨成釉细胞瘤切除及修复重建手术中的应用探讨

doi:10.13591/j.cnki.kqyx.2023.01.011

Abstract

Abstract: Objective Using computer-assisted navigation technology to guide the resection and reconstruction of mandibular ameloblastoma, evaluating its treatment effect. Methods Twelve patients were selected from the Affiliated Stomatological Hospital of Nanjing University from January 2017 to May 2022. All 12 patients accepted same surgery which included resection of mandibular ameloblastoma and reconstruction by fibula musculocutaneous flap. Among them, 6 cases were included in the navigation group; 6 cases were in the non-navigation group. Advantages and disadvantages of computer-assisted navigation technology in this operation were evaluated with these cases. Results The 12 operations were performed by the same operator. The average time for fixing the navigation bracket and performing navigation in the navigation group was about 15 minutes. Compared with the non-navigation group, the average operation time in the navigation group was shortened by about 10 minutes. In the navigation group, the mandible resection range matched the fibula musculocutaneous flap well, and the occlusal relationship recovered well. Conclusion Using the mandibular reference frame, under the guidance of computer-assisted navigation technology, the resection and reconstruction of mandibular ameloblastoma can be performed quickly and accurately.

Key words: computer-assisted navigation technology, ameloblastoma, mandibular reference frame, real-time navigation

CLC Number:

R739.82

LIU Min, TANG Enyi, LIU Zhe, GE Sumeng, WU Zhuhao, ZHANG Xingwei, SUN Guowen. Application of computer-assisted navigation technology in the resection and reconstruction of mandibular ameloblastoma[J]. Stomatology, 2023, 43(1): 62-69.

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References 22

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病例	性别	年龄 /岁	诊断	病灶部位	CT检查测量最大截面范围/(cm×cm)	影像资料典型表现
1	女	39	左下颌骨成釉细胞瘤	下颌骨体部	2.9×2.7	颌骨颊舌向膨隆,呈类圆形多房囊性骨质吸收
2	男	28	右下颌骨成釉细胞瘤	下颌骨体部及升支	3.9×3.1	颌骨颊舌向膨隆,累及牙齿牙根呈截根样吸收
3	女	66	左下颌骨成釉细胞瘤	下颌骨体部	3.5×2.2	颌骨颊舌向膨隆,呈多房大小不等囊性及蜂窝状低密度影
4	男	30	右下颌骨成釉细胞瘤	下颌骨体部	4.5×2.7	颌骨颊舌向膨隆,呈类圆形多房囊性骨质吸收,累及牙根呈截根状、锯齿状吸收及移位
5	女	66	左下颌骨成釉细胞瘤	下颌角(体部及升支)	3.1×1.3	颌骨内多房大小不等囊性及蜂窝状低密度影
6	男	45	右下颌骨成釉细胞瘤	下颌角(体部及升支)	3.6×3.2	44、45牙根截根样吸收,颌骨颊舌向膨隆,呈多房囊性骨质吸收
7	男	34	右下颌骨成釉细胞瘤	下颌骨体部及升支前缘	4.2×3.8	颌骨呈多房囊性骨质吸收,颊舌向膨隆明显
8	女	50	左下颌骨成釉细胞瘤	下颌骨体部	3.5×2.5	33—36牙根呈截根样吸收
9	男	56	右下颌骨成釉细胞瘤	下颌骨体部	3.6×2.4	46牙根截根样吸收,46至下颌升支前缘呈多房囊性骨质吸收
10	男	36	右下颌骨成釉细胞瘤	下颌骨体部及升支前缘	4.8×3.5	右下颌后牙至磨牙后区见多房囊性骨质吸收,颊舌向膨隆明显
11	女	40	左下颌骨成釉细胞瘤	下颌骨体部及升支	2.7×3.8	颌骨颊舌向膨隆,多房大小不等囊性低密度影,37呈截根样吸收
12	女	42	左下颌骨成釉细胞瘤	下颌骨体部及升支	4.6×2.9	颌骨颊舌向膨隆,下颌骨神经管受推下移,37、38呈截根样吸收

Application of computer-assisted navigation technology in the resection and reconstruction of mandibular ameloblastoma

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病例	手术时间/min	导航时间/min	UW-QOL调查问卷-外形/分	UW-QOL调查问卷-咀嚼/分	术前张口度/cm	术后张口度/cm
1	315	15	72	70	3.7	3.6
2	280	12	78	75	3.5	3.5
3	300	20	80	77	3.2	3.2
4	310	10	75	73	3.5	3.3
5	285	15	82	69	3.5	3.5
6	310	18	79	70	3.4	3.4
7	320	-	80	72	3.7	3.5
8	295	-	75	65	3.2	3.1
9	300	-	68	60	3.5	3.1
10	320	-	72	72	3.7	3.5
11	310	-	70	68	3.4	3.2
12	315	-	76	66	3.6	3.5

[1]	. Expression and significance of E-cadherin and vimentin in ameloblastoma and odontogenic cyst [J]. , 2018, 38(4): 300-304.
[2]	. Comparative study on the CBCT image of the mandibular ameloblastoma and keratocystic odontogenic tumor [J]. , 2018, 38(4): 320-323.

病例	手术时间/min	导航时间/min	UW-QOL调查问卷-外形/分	UW-QOL调查问卷-咀嚼/分	术前张口度/cm	术后张口度/cm
1	315	15	72	70	3.7	3.6
2	280	12	78	75	3.5	3.5
3	300	20	80	77	3.2	3.2
4	310	10	75	73	3.5	3.3
5	285	15	82	69	3.5	3.5
6	310	18	79	70	3.4	3.4
7	320	-	80	72	3.7	3.5
8	295	-	75	65	3.2	3.1
9	300	-	68	60	3.5	3.1
10	320	-	72	72	3.7	3.5
11	310	-	70	68	3.4	3.2
12	315	-	76	66	3.6	3.5

病例	手术时间/min	导航时间/min	UW-QOL调查问卷-外形/分	UW-QOL调查问卷-咀嚼/分	术前张口度/cm	术后张口度/cm
1	315	15	72	70	3.7	3.6
2	280	12	78	75	3.5	3.5
3	300	20	80	77	3.2	3.2
4	310	10	75	73	3.5	3.3
5	285	15	82	69	3.5	3.5
6	310	18	79	70	3.4	3.4
7	320	-	80	72	3.7	3.5
8	295	-	75	65	3.2	3.1
9	300	-	68	60	3.5	3.1
10	320	-	72	72	3.7	3.5
11	310	-	70	68	3.4	3.2
12	315	-	76	66	3.6	3.5