正畸正颌联合治疗唇腭裂继发牙颌面畸形

目的评价正畸正颌联合治疗唇腭裂继发牙颌面畸形的疗效。方法回顾性研究2000年7月～2005年9月广东省口腔医院治疗的20例唇腭裂继发牙颌面畸形患者。20例患者均行术前及术后正畸治疗,单纯采用上颌骨LeFortⅠ型截骨前移者1例,单纯采用双侧下颌升支矢状劈开后退术者1例,行LeFortⅠ型截骨前移术 双侧下颌升支矢状劈开后退术者15例,行LeFortⅠ型截骨前移术 双侧下颌升支矢状劈开后退术 颏成型术者3例。17例患者在正颌手术前行牙槽裂植骨。结果经治疗患者上颌前移(5.5±1.2)mm,下颌后退(7.2±2.5)mm。患者唇颏关系改善明显,咬合关系良好,但大部分患者鼻部仍有塌陷及偏斜畸形。患者术前后语音状况经语音师评估均无明显变化。结论正畸正颌联合治疗唇腭裂继发牙颌面畸形,可以较好地改善患者的容貌并取得良好的咬合关系。     

双侧升支矢状劈开截骨后退下颌术后骨的稳定性的研究

目的：探讨双侧升支矢状劈开截骨术（BSSRO）后退下颌骨以钢丝结扎固定两骨段加颌间固定术后骨的稳定性，了解导致复发的有关因素。方法：双侧下颌升支矢状劈开截骨手术后退下颌的患者14例，于手术前1周，手术后1周，术后6个月分别拍摄定位头颅侧位片及许勒位X线片，用于测量下颌移动的距离及确定下颌骨髁状突的位置。结果：双侧下颌升支矢状劈开截骨后退术后，6个月的复发率为27.2%，多元逐步回归分析示下颌后退的距离与复发相关。结论：BSSRO后退下颌骨的距离越大，术后下颌骨向前移位的可能越大。     

下颌升支矢状劈开截骨术后颞下颌关节形态和功能变化

下颌升支矢状劈开截骨术 (ＢＳＳＲＯ)对颞下颌关节(ＴＭＪ)形态和功能的影响是很多学者研究的问题 ,且对下颌升支矢状劈开截骨术后颞下颌关节是否发生形态改变和关节功能紊乱存在争议[1] 。本文通过 16例下颌升支矢状劈开截骨术的病例对颞下颌关节是否发生形态改变和关节功能紊乱进行了随访研究。1　材料与方法1.1　一般临床资料1996年 1月～ 2 0 0 1年 12月共 130例正颌外科手术。从中选出 16例下颌双侧升支施行矢状劈开截骨术 (ＢＳＳＲＯ)的病例进行随访研究 ,其中女 7例 ,男 9例 ,平均年龄 2 3.5 (18～ 2 6 )岁。下颌前突 11例 ,上颌后…     

下颌支矢状骨劈开术的数字仿真及其稳定性研究

下颌支矢状劈开截骨术(SSRO)是最早被提出的口内进路的正颌外科手术,广泛应用于矫治下颌后缩、下颌前突、小颌畸形等各类牙颌面畸形。目前临床上对于下颌支矢状骨劈开术采用了不同的内固定方式,其稳定性的差异仍存在争议。近年来随着计算机技术的推广应用,特别是数字仿真技术运用在口腔医学领域,为下颌支矢状骨劈开术的稳定性分析提供了新的研究着手点。从骨劈开术式到内固定方式都在不断地改良与完善,提高了正颌手术效果、降低了复发率及颞颌关节功能紊乱综合征等并发症的发生。本文就下颌支矢状骨劈开术坚强内固定术的数字仿真及其生物力学稳定性研究进展作一综述。     

下颌偏突颌畸形患者手术前后（牙＋合）力、咀嚼效能的变化

目的：研究下颌偏突颌畸形患者手术前后胎力,咀嚼效能的变化,并探讨其影响因素．方法：从2008年2月～2008年10月对24例在武汉大学口腔医学院接受正颌手术的下颌偏突颌畸形患者。根据畸形的具体情况,将其分为两组,仅接受双侧下颌升支矢状劈开截骨术16例（单颌治疗组）,接受LeFort Ⅰ型截骨术合并双侧下颌升支矢状劈开截骨术8例（双颌治疗组）。利用咬合力计和分光光度计分别对两组患者术前、术后l、3、6个月的胎力和咀嚼效能进行测定。结果：术后1个月时,两组患者胎力及咀嚼效能显着低于术前。术后3个月时,两组患者胎力和咀嚼效能已有明显改善。术后6个月时,单颌治疗组患者的胎力均值超过术前,而双颌组患者的咀嚼效能均值也高于术前。结论：正颌手术短时间内对下颌偏突颌畸形患者的胎力、咀嚼效能影响较大。随着手术后患者对新的胎关系逐渐适应,其胎力和咀嚼效能均有明显变化。单颌治疗组胎力改善较快,双颌治疗组咀嚼效能提高更明显。     

矫治不良颌间关系与同期种植术

目的 探讨正颌外科方法矫正缺牙区不良咬合关系同时行种植术中的可行性,评估其效果及临床价值。方法 对９例患者行正颌外科手术。其中 上颌Ｌｅ Ｆｏｒｔ Ｉ型截骨术、下颌双侧升支矢状劈开截骨术（ＳＳＲＯ）３例,单纯下颌ＳＳＲＯ１例,下颌前部根上截骨术４例,双侧上颌后部截骨术１例,共植入种植体２５颗。结果 ９例术后均取得了正常的咬合关系,未见感染及术后并发症。术后８个月患者接受种植体上部结构修复,平均追踪     

下颌升支矢状劈开截骨术后髁突和下颌角横向变化的研究

目的 观察下颌升支矢状劈开截骨后退术后下颌骨近心骨段的横向变化及长期稳定性。方法 对42例行双颌手术＋坚固内固定治疗的Ⅲ类错[牙合]畸形患者术前、术后一周以及术后12个月以上的后前住头颅定位片进行描记、定点测量，并作统计学分析。结果 下颌角间距及髁突间距在术中分别增加了4．04mm（P〈0．01）和2．11mm（P〈0．01）；在术后观察期，二者分别减小了1．45mm（P〈0．01）和1．80mm（P〈0．01）；下颌角间距术中增宽量越大，观察期减小的幅度越大。结论 经过升支矢状劈开截骨后退下颌骨远心骨段后，下颌骨近心骨段在横向上发生了一定的移位，后前住头颅定位片上表现为下颌角间距及髁突间距的明显增加；在平均20个月的观察期内，二者有不同程度的回复，下颌角间距较术前呈明显的净增宽。     

不同方法制作正颌手术数字化[牙合]板的研究及精确性分析

目的探讨不同方法制作正颌手术数字化[牙合]板的流程,并评估其精确性及临床应用价值。方法选择2017年6月—2019年2月就诊于昆明医科大学附属口腔医院口腔颌面外科的牙颌面畸形患者10例为研究对象。分别利用单个软件和多个软件进行术前模拟设计,虚拟截骨,设计数字化[牙合]板,并评估二者精确性和工作时间。同时传统模型外科制作传统[牙合]板,评估单软件数字化[牙合]板的临床运用价值。结果单软件数字化[牙合]板最大拟合误差平均值上颌为(0.0111±0.0038)mm,下颌为(0.0107±0.0037)mm。单软件数字化[牙合]板最大拟合误差优于多软件数字化[牙合]板(P<0.001),各自上下颌面间差异无统计学意义(P>0.05)。[牙合]板术中未出现无法就位情况。无论是单颌还是双颌手术,单软件手术模拟时间均少于多软件手术模拟时间。结论不同方法制作数字化[牙合]板精确性存在差异,单软件数字化[牙合]板精确性优于多软件数字化[牙合]板,模拟耗时更少,具有实际应用价值。     

下颌支截骨术后口颌系统的变化

<正>下颌支截骨术在临床应用已有20余年,随着手术器械、手术设备及手术方法的不断改进,加上坚固内固定技术的广泛应用,其在矫治牙颌面畸形方面取得了良好的效果,其中最常用的矫治下颌畸形的术式主要有:下颌支矢状劈开截骨术（sagitta splitramus osteotomy,SSRO）、下颌支垂直截骨术（intrao-     

上颌骨矢状骨折的临床研究

目的：探讨上颌骨矢状骨折的手术治疗方法,方法：收集2001年3月-2009年10月收治的45例上颌骨矢状骨折病例,通过LeFortⅠ型截骨术治疗,对手术效果进行分析。结果：Le FortⅠ型截骨术治疗上颌骨矢状骨折均获得良好疗效,患者面型和咬合关系恢复满意,无严重手术并发症。结论：LeFortⅠ型截骨术是治疗上颌骨矢状骨折的有效手术方法,术前应依照正颌外科原则进行模型外科准备,术中应同期进行其它面骨的复位固定。     

Reproducibility of a three-dimensional skeletal-based craniofacial orientation method for virtual surgical planning

Inadequate craniofacial orientation of computed tomography (CT) scans can have significant implications in all three planes of space. The purpose of this study was to present the reproducibility of a 3-dimensional skeletal-based method of craniofacial orientation for virtual surgical planning. The protocol was defined by landmarks commonly used for cephalometry, and required identification of basion, nasion, right porion, and right orbitale, and navigation in all CT views (coronal, sagittal, and axial) for correction of yaw, roll, and pitch. Reproducibility of the method was assessed using eight CT scans that were randomly selected and anonymised. The observer group consisted of six oral and maxillofacial surgeons with varying levels of experience (resident or faculty) who performed craniofacial orientation according to the proposed method. Results were expected to be below 2° of variation, when overall accuracy as well as the influence of the academic level of the observers and symmetry of the evaluated anatomy, were considered as independent variables. Overall accuracy for all cases and for yaw, roll, and pitch were always below 2° of variation, without influence of level of experience and symmetry. Interobserver assessment was categorised as excellent in all instances, and intraobserver evaluation demonstrated consistency in the orientation of all axes. The proposed craniofacial orientation protocol presented in this study is easy to learn, applicable to computer-aided surgical planning, and can be performed by the non-technical clinician, resulting in excellent reproducibility and consistency.     

颅面外科三维诊断分析和手术设计系统的建立

目的　探讨正常颅面结构内在美学规律、研究复杂颅面畸形的解剖结构特征及其整复手术设计方法。方法　建立了颅颌面外科三维诊断分析和手术设计计算机系统 (3DCMFCADS) ,并将系统应用于正常颅面分析和颅面畸形整复手术设计。结果　所建系统整机运行稳定 ,测量分析误差微小 ,精密度最大变异系数仅 1.92 % ,手术模拟设计和构建的移植体或植入体三维模型形态逼真、参数准确。所建系统和方法的优特点表现在 :1可同时显示硬、软组织结构并对其进行三维测量分析和手术模拟设计。 2可显示颅面立体结构 ;可定性和定量地诊断分析颅面畸形 ;可进行手术模拟并设计移植或植入修复体三维模型。 3可利用国内较普及的 CT扫描机和微型计算机设备开展工作 ,系统操作方法易于为外科医生掌握使用 ,具有临床实用性。 4定量诊断和手术设计的准确性、精密度高 ,且具有客观性。结论　 3DCMFCAD系统和方法的建立为颅面畸形形成机制研究、诊断分析、手术设计和疗效评价提供了新的科学方法和理论依据。     

Computed tomography assessment of Apert syndrome

Apert syndrome, or acrocephalosyndactyly type I, is a craniofacial dysostosis, an autosomal dominant condition characterized by severe developmental disturbances of the craniofacial region including bilateral coronal synostosis associated with midface hypoplasia, exophthalmia, hypertelorism, and symmetric syndactyly of the hands and feet. The aim of this study is to assess the clinical and computed tomography imaging patterns of non-operated patients with Apert syndrome, correlating the bone abnormalities of the cranium, face and the skull base. The study population consisted of 5 patients with Apert syndrome. As part of the craniofacial assessment of the imaging center's routine, all patients underwent clinical evaluation and CT (computed tomograph) exam. Three-dimensional images were generated from helical CT scans, using an independent workstation, to evaluate the craniofacial abnormalities of the syndrome. Clinical exam determined that syndactyly of the hands and feet, pseudocleft in the midline palate and midface hypoplasia were features observed in all of the Apert patients. 3D-CT showed that some abnormalities such as bilateral coronal synostosis, calvarial midline defect and reduction in the antero-posterior dimension of the anterior, medial and posterior cranial fossae were present in all cases. In conclusion, the correlation of clinical and CT imaging findings can be useful to assess the main features observed in Apert patients, improving the criteria for examining the patient and diagnosing this condition, and contributing to the therapeutic planning and surgical follow-up.     

CT-based size and shape determination of the craniofacial skeleton: a new scoring system to assess bony deformities in hemifacial microsomia

The purpose of this study was to design a better craniofacial classification system for bony deformities in patients with hemifacial microsomia than the existing ones. It was meant to incorporate the deformity of the craniofacial skeleton other than that of the mandible. The "Mandibular Deformity Scoring" System (MDS), the "Cranial Deformity Scoring" System (CDS), the the "Craniofacial Deformity Scoring" System (CFDS) are three newly developed classification systems, which are based on three-dimensional computed tomography (3-D CT) reconstructions. The size and shape of the craniofacial structures of 34 children, 25 with hemifacial microsomia and 9 with minimal dysplasia or trauma, were determined from CT scans, using 3-D image segmentation and rendering. Contiguous 1.5-mm CT scans were made using a Philips Tomoscan 350 and were processed using a Cemax 1500X 3-D workstation. The precision of the 3-D imaging was assessed by repeated determinations carried out by two observers (intra- and interreliability). Accuracy of the bone determination technique was assessed by comparing the interpretations of the craniofacial skeleton by 3-D CT reconstructions of laser-stereolithographic 3-D models. Correlations of the Pruzansky/Kaban classification system and the newly developed classification systems were demonstrated by the use of the Pearson product moment correlation coefficients. The new CFDS (= CDS + MDS) provides an adequate basis for assessment of bony structures using three-dimensional imaging and demonstrates a high correlation with the known Pruzansky/Kaban classification system. This new scoring system can handle the wide variety of individual variation of the deformity seen in patients with hemifacial microsomia better than the existing scoring systems.     

Craniofacial skeletal measurements based on computed tomography: Part I. Accuracy and reproducibility.

Computed tomography (CT) is a useful modality for the management of craniofacial anomalies. A study was undertaken to assess whether CT measurements of the upper craniofacial skeleton accurately represent the bony region imaged. Measurements taken directly from five dry skulls (approximate ages: adults, over 18 years; child, 4 years; infant, 6 months) were compared to those from axial CT scans of these skulls. Excellent agreement was found between the direct (dry skull) and indirect (CT) measurements. The effect of head tilt on the accuracy of these measurements was investigated. The error was within clinically acceptable limits (less than 5 percent) if the angle was no more than +/- 4 degrees from baseline (0 degrees). Objective standardized information gained from CT should complement the subjective clinical data usually collected for the treatment of craniofacial deformities.     

Three-dimensional computed tomography landmark measurement in craniofacial surgical planning: experimental validation in vitro.

PURPOSE: This study evaluated the measurement accuracy of three-dimensional (3D) volumetric images from spiral computed tomography (CT) in vitro. MATERIALS AND METHODS: The study sample consisted of nine cadaver heads that were submitted to an impact force by a special device to promote blunt traumatic craniofacial fractures. The heads were subsequently scanned by a spiral CT scanner (Toshiba Xpress S/X). The archived CT data were transferred to networked computer workstations (Sun Microsystems with Cemax VIP version 1.4 software) to generate 3D volumetric images. The visualization software was used to make interactive linear measurements on the 3D images. Measurements were made on the images twice by two observers, based on conventional craniofacial anatomic landmarks. The soft tissues were subsequently removed, and the same measurements were repeated on the cadaver heads with an electromagnetic digitizer (3 Space, Polhemus, Colchester, VT). RESULTS: The results showed no statistically significant differences between the 3D-CT and the physical measurements, with P>.05 for all measurements. The mean difference between the image and real measurements was less than 2 mm in all instances. CONCLUSIONS: It is concluded that measurement of the skull and facial bone landmarks by 3D reconstruction is quantitatively accurate for surgical planning and treatment evaluation of craniofacial fractures.     

颅面部螺旋CT三维线距测量的准确性评价

目的:研究颅面部螺旋CT三维线距测量与实测距离的一致性。方法:选择12个干燥头颅,采用GE公司16层螺旋CT常规扫描后,将头颅数据转至工作站,进行颅颌面三维重建。选择正畸常用的16个颅面骨性解剖标志点,分别使用DisplayTools测量工具和游标卡尺进行20个项目测量。采用SAS9.0统计软件包进行配对t检验,比较螺旋CT三维线距测量与实测距离的一致性。结果:螺旋CT三维线距测量与游标卡尺实测结果相比,P值范围为0.0995～0.9812,所有测量项目均无显著性差异。结论:螺旋CT体绘制图像颅面解剖标志点间线性距离与实测距离具有一致性,螺旋CT三维测量有望替代实际测量,用于头影测量分析。     

颅内外沟通性肿瘤切除术后脑脊液漏的治疗和预防

目的:探讨颅底沟通性肿瘤切除术后脑脊液漏的防治措施。方法:通过回顾性研究方法,对14例颅颌面联合肿瘤切除术后脑脊液漏患者的临床资料进行分析和总结。结果:10例(71.4%)脑脊液漏患者经保守治疗和腰池引流,于3～32d内治愈,4例(28.6%)行手术修补,其中3例1次修补成功,1例2次修补成功。全组共5例(35.7%)并发颅内感染,1例(7.1%)死亡。结论:持续腰池引流对大部分术后脑脊液漏患者是安全有效的,经保守治疗无效或间断性反复发作的患者,建议应用多层重建技术修补漏口,以免引起颅内感染。术中严密修补硬脑膜和重建颅底缺损,消灭死腔是预防术后脑脊液漏的关键。