Journal of Cranio-Maxillofacial Surgery最新文献_第2页

Saving lives and restoring hope: Enhancing outcomes through comprehensive understanding of maxillofacial surgery in disaster medicine 拯救生命，重燃希望：通过全面了解颌面外科在灾难医学中的应用来提高疗效。

IF 2.1 2区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Cranio-Maxillofacial Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jcms.2024.03.019

Ricardo Grillo , Sahand Samieirad , Yunus Balel , Alexandre Meireles Borba , Philippi Machado dos Reis , Fernando Melhem-Elias

This article delves into the profound impact of various types of disasters, examining some specific contexts. It provides insights into the unique challenges posed by different disasters, ultimately highlighting the invaluable role of maxillofacial surgery in addressing the critical healthcare needs of affected populations.

A comprehensive review of the literature was conducted to analyze the role of maxillofacial surgery in disaster management. Relevant studies were examined to gather evidence supporting the criticality of maxillofacial surgeons in disaster response.

Continuous training, coordination, and international collaboration among maxillofacial surgeons were reported as key factors in enhancing preparedness and improving post-disaster recovery. Sharing experiences, implementing best practices, and staying updated with advancements in the field seemed crucial for maximizing the impact of maxillofacial surgery in disaster medicine.

By prioritizing the inclusion of maxillofacial surgeons in disaster response teams, lives can be saved, functional outcomes can be improved, and hope can be restored in affected communities. Understanding the intricacies and patterns associated with various types of disasters can be crucial details for successful rescue operations.

本文深入探讨了各类灾害的深远影响，并对一些具体情况进行了研究。文章深入探讨了不同灾害带来的独特挑战，最终强调了颌面外科在满足受灾人口关键医疗需求方面的宝贵作用。为了分析颌面外科在灾害管理中的作用，我们对文献进行了全面的回顾。对相关研究进行了审查，以收集支持颌面外科医生在灾难应对中的关键作用的证据。据报道，颌面外科医生之间的持续培训、协调和国际合作是加强备灾和改善灾后恢复的关键因素。分享经验、实施最佳实践以及随时了解该领域的最新进展似乎对最大限度地发挥颌面外科学在灾难医学中的影响至关重要。通过将颌面外科医生优先纳入救灾团队，可以挽救生命，改善功能结果，并为受灾社区重燃希望。了解与各类灾害相关的错综复杂的情况和模式是成功开展救援行动的关键细节。

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引用次数: 0

Comprehensive analysis of alar base inclination and lip line cant following orthognathic correction of maxillomandibular asymmetry: A retrospective study 上颌下颌不对称正颌矫正术后的颏底倾斜度和唇线倾斜度综合分析：回顾性研究

IF 2.1 2区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Cranio-Maxillofacial Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jcms.2024.08.018

Onur Koç, Salih Eren Meral, Emre Tosun, Hakan Hıfzı Tüz

This paper examines the relationship between roll rotation of the jaws and changes in alar base or lip line asymmetry in the coronal plane following orthognathic correction. The study involved patients with preoperative frontal alar base and lip line asymmetries greater than 0.5° (because it corresponds to the minimum asymmetry perception threshold) and underwent bimaxillary orthognathic surgery without (Group I) or with (Group II) genioplasty. The alar base angle (ABA), lip line cant angle (LLCA), maxillary cant angle (MxCA), and mandibular cant angle (MnCA) were measured using preoperative and 12 months postoperative cone beam computed tomography (CBCT) images. Thirty-four patients were included in the study. Significant correlations were found between changes in MxCA and ABA besides between changes in MnCA and LCA in Groups I (P = 0.016, P˂0.001, respectively) and II (P = 0.002, P˂0.001, respectively). The mean of the change in ABA/the change in MxCA and the change in LLCA/the change in MnCA ratios for Group I were 0.59 ± 1.57 and 0.73 ± 0.94, respectively, while those for Group II were 0.46 ± 3.70 and 0.39 ± 2.00, respectively. Angular measurements from jugular and mental foramina points, aligned with the bony midline, offer a convenient tool for predicting alar base and lip symmetry during bimaxillary orthognathic surgery planning.

本文探讨了下颌滚动旋转与正颌矫正后冠状面上颌底或唇线不对称变化之间的关系。研究对象为术前额面颏底和唇线不对称度大于 0.5°（因为这相当于最小不对称感知阈值）并接受了双颌正颌手术的患者，这些患者未接受基因成形术（第一组）或接受了基因成形术（第二组）。使用术前和术后 12 个月的锥形束计算机断层扫描（CBCT）图像测量了齿根角（ABA）、唇线倾斜角（LLCA）、上颌倾斜角（MxCA）和下颌倾斜角（MnCA）。研究共纳入 34 名患者。在第一组（P = 0.016，P˂0.001）和第二组（P = 0.002，P˂0.001）中，除了 MnCA 和 LCA 的变化外，MxCA 和 ABA 的变化之间也存在显著相关性。I 组 ABA 变化/MxCA 变化和 LLCA 变化/MnCA 变化的平均比率分别为 0.59 ± 1.57 和 0.73 ± 0.94，而 II 组分别为 0.46 ± 3.70 和 0.39 ± 2.00。以骨中线为准线，从颈静脉和精神孔点进行角度测量，为在双颌正颌手术规划中预测耳廓基底和嘴唇对称性提供了方便的工具。

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引用次数: 0

Patient satisfaction after conservative treatment of anterior wall frontal sinus fractures 前壁额窦骨折保守治疗后的患者满意度。

IF 2.1 2区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Cranio-Maxillofacial Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jcms.2024.08.002

Marlous Marianne Beate Cardinaal , Omid Daqiq , Bram Barteld Jan Merema, Baucke van Minnen

This study aims to determine patient forehead aesthetics satisfaction after conservative treatment of non-dislocated and dislocated anterior wall frontal sinus fractures.

Prospectively, patients older than 15 years of age with a frontal sinus fracture, treated conservatively between the period of 2010–2020, were analysed. The Face-Q questionnaire was used to assess patient satisfaction, and the fracture dimensional properties were measured using computed tomography. The results were compared with a matched non-fractured control group.

The mean total Face-Q questionnaire score was 114.77 (SD = 17.38) versus 114.23 (SD = 15.23) (research-versus control group, respectively), with a mean difference of 0.55 (SD = 4.85), which was not significant (p = 0.91). The size of impression area did not appear to have a linear relationship with patient satisfaction within the entire population (p = 0.87; r = 0.00). Presence of a scar in the fracture site was a significant predictor of patient satisfaction, contributing to 31% of the entire population's overall score (p = 0.01) and 57% in the dislocated fracture population (p = 0.003).

The conservatively treated patients’ satisfaction score was comparable to the control group. A higher satisfaction score after a conservative treatment is associated with the absence of a scar on the fracture site, even with dislocations up to 6 mm at the deepest impression point.

本研究旨在确定患者对前壁额窦非脱位和脱位骨折保守治疗后的额部美学满意度。研究对 2010-2020 年间接受保守治疗的 15 岁以上额窦骨折患者进行了前瞻性分析。采用 Face-Q 问卷评估患者的满意度，并使用计算机断层扫描测量骨折的尺寸特性。结果与匹配的非骨折对照组进行了比较。研究组与对照组的 Face-Q 问卷平均总分分别为 114.77（SD = 17.38）和 114.23（SD = 15.23），平均差异为 0.55（SD = 4.85），差异不显著（P = 0.91）。在整个人群中，压痕面积的大小与患者满意度似乎没有线性关系（p = 0.87；r = 0.00）。骨折部位有无疤痕是患者满意度的重要预测因素，占整个人群总分的 31% (p = 0.01)，在脱位骨折人群中占 57% (p = 0.003)。保守治疗患者的满意度得分与对照组相当。保守治疗后较高的满意度得分与骨折部位无疤痕有关，即使脱位最深印模点达 6 毫米。

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引用次数: 0

Osteosynthesis for mandibular reconstruction with fibula free flap: Which type and why? A French national survey 使用腓骨游离瓣进行下颌骨重建的骨合成术：哪种类型？法国全国调查。

IF 2.1 2区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Cranio-Maxillofacial Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jcms.2024.03.018

Hugo Poncet, Frédéric Lauwers, Franck Delanoë, Alexandra Roux-Trotobas, Alice Prevost

We explored the most suitable osteosynthesis type for mandibular reconstruction using fibula free flap (FFF) given the lack of robust data available. For this, an anonymous survey was e-mailed to 853 head-and-neck surgeons (France) asking about their practices and criteria guiding their osteosynthesis material and method choices. Questions assessed: (1) the most frequently used osteosynthesis type, (2) the explanatory variables related to surgeon career status/surgical specialty, and (3) justifications for osteosynthesis type (scientific, technical, "misuse"). Multivariate logistic regression was performed to test for associations of explanatory variables with plate type or misuse. Overall, 118 (13.8%) surgeons responded, among which flexible non-locking osteosynthesis was preferred (59%). Career status and surgical specialty were significantly associated with material choice. University professors/senior lecturers (OR 5.96 vs academic clinical associates; p = 0.02), but not ear-nose-throat/reconstructive plastic surgeons (OR 0.22 vs maxillofacial surgeons; p = 0.04), were more likely to opt for rigid locking osteosynthesis. Private practitioners preferred flexible non-locking osteosynthesis (OR = 5.03; p = 0.04). Only 18% of surgeons scientifically justified their choices. We considered misuse among 65% of surgeons and this was significantly associated with irregular practice of FFF surgery (OR 2.28 vs > 10 surgeries/year; p = 0.04). Overall, >50% of surgeons mainly rely on habits without scientific arguments assisting in decision-making.

由于缺乏可靠的数据，我们探讨了使用腓骨游离瓣（FFF）进行下颌骨重建的最合适的骨合成类型。为此，我们通过电子邮件向 853 名头颈外科医生（法国）发送了匿名调查问卷，询问他们在选择骨合成材料和方法时的做法和指导标准。调查问题包括：(1) 最常用的骨合成类型；(2) 与外科医生职业状况/外科专业相关的解释变量；(3) 骨合成类型的理由（科学、技术、"滥用"）。我们进行了多变量逻辑回归，以检验解释变量与钢板类型或滥用之间的关联。共有 118 名外科医生（13.8%）做出了回应，其中 59% 的外科医生首选柔性非锁定骨合成术。职业状况和外科专业与材料选择有显著关联。大学教授/高级讲师（OR 5.96 vs 临床学术助理；p = 0.02）更倾向于选择刚性锁定骨合成，而耳鼻喉/整形外科医生（OR 0.22 vs 颌面外科医生；p = 0.04）则不然。私人执业医师则更倾向于使用灵活的非锁定骨合成术（OR = 5.03；p = 0.04）。只有 18% 的外科医生为自己的选择提供了科学依据。我们认为 65% 的外科医生存在滥用现象，这与 FFF 手术的不规范操作密切相关（OR 2.28 vs > 10 例手术/年；p = 0.04）。总体而言，超过 50% 的外科医生主要依靠习惯，而没有科学依据辅助决策。

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引用次数: 0

Medial incision approach in modified small double-opposing Z-plasty for Veau II cleft repair 内侧切口法用于 Veau II 兔裂修复的改良小双对位 Z 形成形术

IF 2.1 2区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Cranio-Maxillofacial Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jcms.2024.06.005

Rafael Denadai , Nobuhiro Sato , Hyung Joon Seo , Dax Carlo Go Pascasio , Chi-Chin Lo , Pang-Yung Chou , Lun-Jou Lo

An encouraging outcome was described for the use of modified Furlow small double-opposing Z-plasty (sDOZ) using the medial incision (MIsDOZ) approach in repair of Veau type I cleft palate. This retrospective study assessed early results of using extended indication criterion of MIsDOZ for the management of consecutive non-syndromic patients with Veau II cleft palate treated by a single surgeon. Bardach two-flap plus sDOZ (two-flap approach) or medial incision approach with a tension-driven stepwise application of lateral palatal incisions (soft palate only, von Langenbeck type, or two-flap type) were applied. Surgical (age, cleft width, operative time, hospital stay, and complication)- and auditory-perceptual assessment-related data were collected. Two-flap approach (n = 21) demonstrated a significantly (p < 0.001) increased operative time (132.8 ± 12.2 versus 114.8 ± 19.9 min, respectively) and higher use of lateral incisions (100% versus 44.4%) than medial incision approach (n = 27), with no significant (p > 0.05) difference for age at surgery (13.0 ± 6.1 versus 13.6 ± 5.8 months), cleft width (8.5 ± 4.1 versus 8.7 ± 3.8 mm), hospital stay (1.0 ± 0 versus 1.0 ± 0 day), and complication (0% versus 0%) and hypernasality (9.5% versus 7.4%) rates. In conclusion, the medial incision approach for Veau II cleft repair resulted in reduced need for lateral palatal incision with no increase of complication or hypernasality rates.

在修复 Veau I 型腭裂时，使用内侧切口的改良 Furlow 小双对位 Z 形成形术（sDOZ）（MIsDOZ）取得了令人鼓舞的结果。这项回顾性研究评估了使用 MIsDOZ 扩展适应症标准治疗由一名外科医生治疗的连续非综合征 Veau II 型腭裂患者的早期效果。采用了巴达赫双瓣加sDOZ（双瓣法）或内侧切口法，并在张力驱动下逐步应用腭侧切口（仅软腭、von Langenbeck型或双瓣型）。收集了与手术（年龄、裂隙宽度、手术时间、住院时间和并发症）和听觉感知评估相关的数据。与内侧切口法（n = 27）相比，两瓣法（n = 21）的手术时间（分别为 132.8 ± 12.2 分钟对 114.8 ± 19.9 分钟）显著增加（p < 0.001），侧切口的使用率（100% 对 44.4%）也更高，但手术年龄（p > 0.05），手术年龄（13.0±6.1 个月对 13.6±5.8 个月）、裂隙宽度（8.5±4.1 毫米对 8.7±3.8 毫米）、住院时间（1.0±0 天对 1.0±0 天）、并发症（0% 对 0%）和耳鸣过多（9.5% 对 7.4%）的发生率均无明显差异。总之，采用内侧切口法进行 Veau II 兔裂修复术减少了腭侧切口的需要，但并发症和腭咽下垂的发生率并未增加。

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引用次数: 0

Long-term outcomes of nonsyndromic isolated unilateral lambdoid craniosynostosis 非综合症孤立性单侧羊角颅畸形的长期预后。

IF 2.1 2区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Cranio-Maxillofacial Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jcms.2024.08.006

Jinggang J. Ng, Ashley E. Chang, Benjamin B. Massenburg, Dominic J. Romeo, Meagan Wu, Jessica D. Blum, Jordan W. Swanson, Jesse A. Taylor, Scott P. Bartlett

This study combined qualitative and quantitative approaches to evaluate outcomes of isolated nonsyndromic unilateral lambdoid synostosis at the Children's Hospital of Philadelphia. Volumetric, linear, and angular analyses were performed on long-term postoperative and normal control scans. Preoperative and postoperative clinical photographs were evaluated for the presence of dysmorphic frontofacial features. Among 26 included patients, median age of surgery was 10 months and mean postoperative follow-up was 5.9 ± 5.7 years. Two (7.7%) patients underwent secondary cranial vault procedures. At most recent follow-up, 2 (7.7%) subjects reported intermittent headaches. Twenty (90.9%) of 22 patients were assigned Whitaker grade I. Among 9 subjects with long-term imaging at age 11.5 ± 5.3, posterior vault asymmetry, posterior fossa deflection angle, cranial base angle, and ear position asymmetry all remained greater than in the control group. Of subjects included in the frontofacial feature analysis (n = 10), 50% had resolution of all dysmorphic frontofacial features present preoperatively. Overall, most subjects who underwent PVR did not require revisional surgery and had good outcomes both aesthetically and functionally. Despite residual abnormalities in the cranial base and posterior vault, most had resolution of parietal bossing and facial scoliosis. Ear position asymmetry was the most common dysmorphic feature at long-term follow-up.

这项研究结合了定性和定量方法，对费城儿童医院的孤立性非综合症单侧羊角状突触症的治疗效果进行了评估。对术后长期扫描结果和正常对照组扫描结果进行了体积、线性和角度分析。对术前和术后的临床照片进行了评估，以确定是否存在畸形前额面部特征。在纳入的 26 名患者中，中位手术年龄为 10 个月，平均术后随访时间为 5.9 ± 5.7 年。两名患者（7.7%）接受了二次颅顶手术。在最近的随访中，2 名受试者（7.7%）报告有间歇性头痛。22 名患者中有 20 名（90.9%）被评为惠特克 I 级。9 名患者在 11.5 ± 5.3 岁时接受了长期影像学检查，其中后穹窿不对称、后窝偏转角、颅底角和耳位置不对称均大于对照组。在前额面部特征分析中（n = 10），50% 的受试者术前存在的所有前额面部畸形特征都得到了改善。总体而言，大多数接受前额畸形矫正术的受试者都不需要再次手术，而且在美观和功能方面都取得了良好的效果。尽管颅底和后穹隆仍有残留异常，但大多数人的顶骨凸出和面部脊柱侧凸问题都得到了解决。耳位不对称是长期随访中最常见的畸形特征。

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引用次数: 0

Cleft lip re-repair: How does it affect the nasolabial appearance? 唇裂修复：唇裂对鼻唇沟外观有何影响？

IF 2.1 2区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Cranio-Maxillofacial Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jcms.2024.08.013

Markus Merkl , Vasco Starke , Michala Ivanic-Sefcikova, Marc Brommer, Wolfgang Zemann, Michael Schwaiger

Cleft lip re-repair is a procedure frequently endorsed to enhance a compromised nasolabial appearance. However, the actual effect of such revision surgery on the nasolabial appearance has scarcely been studied. Therefore, the aim of this study was to critically review surgical outcomes of patients that underwent surgical re-do of their cleft lip, using well-validated objective and subjective methods and standardised outcome measures.

20 patients with at least 6 months follow-up after cleft lip re-repair were assessed. Standardised pre- and postoperative photographs were analysed. The objective assessment was carried out using the SymNose-software. Furthermore, a subjective evaluation of the nasolabial area was conducted by ten examiners who rated seven parameters using a Likert-scale ranging from 1to5. The objective evaluation showed substantial improvement regarding symmetry values. Significant postoperative decrease in labial asymmetry from 26.42% (±8.13) to 18.77% (±6.28) (p < 0.001) and upper lip asymmetry in relation to the facial midline (26.91% (±8.03) vs. 18.27% (±5.17) (p < 0.001)) was observed. Similar results were corroborated in the subjective analysis. Differences regarding the ratings were detected considering the examiners’ professional background and level of expertise. Cleft re-repair was found to significantly improve upper lip symmetry and lead to a more harmonious nasolabial appearance.

唇裂修复术是一种经常被用来改善受损鼻唇外观的手术。然而，此类修复手术对鼻唇外观的实际影响却鲜有研究。因此，本研究的目的是采用经过充分验证的主客观方法和标准化结果测量方法，对接受唇裂修复手术的患者的手术结果进行严格审查。本研究评估了 20 名唇裂修复术后随访至少 6 个月的患者。对标准化的术前和术后照片进行了分析。客观评估使用 SymNose 软件进行。此外，十位检查人员还对鼻唇沟区域进行了主观评估，他们使用李克特量表（1-5分）对七个参数进行了评分。客观评估结果显示，对称值有了显著改善。术后唇部不对称率从 26.42% (±8.13) 显著下降到 18.77% (±6.28) (p

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引用次数: 0

Measuring the esthetic outcome using a three-dimensional facial scanner after parotidectomy and application of vascularized fat flaps 使用三维面部扫描仪测量腮腺切除术和血管化脂肪瓣应用后的美容效果。

IF 2.1 2区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Cranio-Maxillofacial Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jcms.2024.03.003

Philip-Oliver Brzoska , Ralf-Dieter Hilgers , Florian Peters , Ali Modabber , Alireza Ghassemi

Background

Parotidectomy can affect facial symmetry. Our study evaluated the symmetry of different facial areas and upper neck after total parotidectomy and filling the area with vascularized fat flap (VFF).

Methods

Facial symmetry was evaluated in eight patients and a control group matched in terms of gender and age, using a three-dimensional (3D) facial scanner. The operated side was compared with the non-operated side and the symmetry compared with that of the control group. Scanning was performed either within the first year (group 1; n = 5) or after 3 years (group 2; n = 3) postoperatively.

Results

The patients’ cheek and neck areas were found to be significantly more asymmetric, but the cheek area in group 2 was significantly more symmetrical when compared with group 1.

Conclusion

VFF appeared to achieve similar facial symmetry to the matched non-operated group. Time had a positive impact on the facial symmetry. The neck area was the most asymmetric, and proved to be unreliable, regardless of whether any procedure was performed or not.

背景腮腺切除术会影响面部对称性。我们的研究评估了腮腺全切除术并用血管化脂肪皮瓣（VFF）填充该区域后不同面部区域和上颈部的对称性。方法使用三维（3D）面部扫描仪评估了八名患者和一名在性别和年龄方面匹配的对照组的面部对称性。手术侧与非手术侧进行比较，对称性与对照组进行比较。结果发现患者的脸颊和颈部明显更不对称，但与第一组相比，第二组的脸颊部位明显更对称。时间对面部对称性有积极影响。颈部是最不对称的部位，无论是否进行了任何手术，颈部的对称性都是不可靠的。

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引用次数: 0

Maxilla management in “phase II” skeletal surgery for obstructive sleep apnea 阻塞性睡眠呼吸暂停 "二期 "骨骼手术中的上颌骨管理

IF 2.1 2区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Cranio-Maxillofacial Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jcms.2024.02.022

This study investigates the management of patients with obstructive sleep apnea (OSA) who have previously undergone palatal surgery and subsequently undergo maxillomandibular advancement (MMA). The research entails a retrospective analysis of phase II MMA cases from 2017 to 2022. Data encompassing demographics, clinical profiles, pre- and post-operative polysomnographic and radiological findings, surgical techniques, and complications were collected. Out of the 14 patients studied, conservative vestibular approaches were applied universally, with four cases necessitating the sectioning of descending palatine arteries. Results indicate an average maxillary sagittal advancement of 10.07 mm, a mean counterclockwise rotation of the maxillary occlusal plane at 9.35°, and a decline in apnea-hypopnea index from 45.5 to 4.5 events per hour. Surgical success and cure rates were 93.3% and 40%, respectively, with no major complications observed throughout the 45-month follow-up. This study underscores the safe and efficacious application of MMA in OSA patients with prior palatal surgery, offering valuable insights into their management.

本研究调查了阻塞性睡眠呼吸暂停（OSA）患者的治疗情况，这些患者曾接受过腭部手术，随后又接受了上下颌骨前移术（MMA）。研究需要对2017年至2022年的二期MMA病例进行回顾性分析。收集的数据包括人口统计学、临床概况、术前和术后多导睡眠图和放射学检查结果、手术技术和并发症。在所研究的14名患者中，普遍采用了保守的前庭手术方法，其中4例患者需要切开腭降动脉。结果显示，上颌骨矢状面平均前移 10.07 毫米，上颌骨咬合面平均逆时针旋转 9.35°，呼吸暂停-低通气指数从每小时 45.5 次下降到 4.5 次。手术成功率和治愈率分别为 93.3% 和 40%，在 45 个月的随访中未发现重大并发症。这项研究强调了 MMA 在曾接受过腭部手术的 OSA 患者中安全有效的应用，为他们的治疗提供了宝贵的见解。

引用次数: 0

Does the anatomy around the pterygomaxillary suture contribute to the risk of bad fractures in Le Fort I osteotomy? 翼颌缝周围的解剖结构是否会导致 Le Fort I 截骨术中发生骨折的风险？

IF 2.1 2区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Cranio-Maxillofacial Surgery

Pub Date : 2024-11-01 DOI: 10.1016/j.jcms.2024.02.018

Kyoichi Obata , Hideka Kanemoto , Koki Umemori , Kisho Ono , Norie Yoshioka , Akiyoshi Nishiyama , Joe Iwanaga , Soichiro Ibaragi

Le Fort I (LF1) osteotomy, a common orthognathic procedure for the maxilla aimed at achieving maxillary mobility by separating the pterygomaxillary suture, poses a risk of bad fracture that may lead to complications and inadequate mobility. Our study analyzed two- and three-dimensional computed tomography images to identify the anatomical factors associated with bad fractures due to an LF1 osteotomy.

Point ‘a’ is where the lateral pterygomaxillary suture on the axial image aligns with the zygomatic alveolar line near the line used for an LF1 osteotomy, with the base line connecting the bilateral ‘a’ points.Two risk factors were identified on the pterygoid side: (i) when the distance from point ‘a’ to the intersection of the base line and the medial pterygoid plate was <6.0 mm; and (ii) when the distance from the piriform aperture margin to the base line was <44.78 mm. Six risk factors were identified on the maxillary side, including the distance between the most anterior and most lateral points of the internal surface of the maxillary sinus being <31.9 mm. Our analyses revealed that fractures that occur during pterygomaxillary suture separation in an LF1 osteotomy are influenced by anatomical factors of the maxilla and pterygoid process, which form the pterygomaxillary suture.

Le Fort I（LF1）截骨术是一种常见的上颌骨正颌手术，其目的是通过分离翼颌缝来实现上颌骨的活动度，但该手术存在不良骨折的风险，可能导致并发症和活动度不足。我们的研究分析了二维和三维计算机断层扫描图像，以确定与 LF1 截骨造成的不良骨折相关的解剖因素。a "点是轴向图像上翼颌面外侧缝线与颧骨齿槽线对齐的位置，靠近用于 LF1 截骨的线，基线连接双侧 "a "点。

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