超声骨切割技术在正颌外科中的应用

目的：与传统骨切割技术对比,探讨超声骨切割技术在正颌外科应用中的安全性和有效性。方法：本组病例12例,其中男2例,女10例;20～65岁;双颌畸形7例,上颌后缩3例,下颌前突2例;行Le FortⅠ型截骨术10例,下颌升支矢状劈开截骨术8例,下颌全牙列根尖下截骨术1例,颏成形术5例。超声骨刀在切骨时选Ⅰ～Ⅲ级切骨模式,调节出水量,刀头选OT7或OT7A。骨断端行坚强内固定。结果：切割精度高,对周围软组织无损伤,术中出血少,骨断端无坏死,创口一期愈合。结论：与传统骨切割技术对比,超声骨切割技术弥补了其存在的缺点和不足。超声骨刀的技术优势为：1）能识别软硬组织,只切割硬组织,对软组织无损伤,提高了手术安全性;2）切割时产热少,再加上冷水喷雾降温,不会对骨组织产生不可逆性坏死;3）切割时无震动,刀柄握持力轻,可控性强,避免了误操作,提高了切割精度,切割线不受限制,创口清晰,切骨线规则平整。故超声骨切割技术在正颌外科中的应用具有一定实用价值。     

Tissue engineering technology and its possible applications in oral and maxillofacial surgery

Tissue engineering is a rapidly advancing discipline that combines the attributes of biochemical and biomaterial engineering with cell transplantation to create bio-artificial tissues and organs. For the oral and maxillofacial surgeon, the reconstruction of maxillofacial defects in hard and soft tissues is an ongoing challenge. While autologous grafts and vascularised free flaps are the current gold standard, they are not without complications at both the donor and reconstructed sites. Tissue engineering, which aims to create tissue-matched, prefabricated, prevascularised bony or soft tissue composite grafts, or both, therefore has the potential to revolutionise practice in maxillofacial surgery. We review the technology of tissue engineering and its current and future applications within the specialty, and discuss contemporary obstacles yet to be overcome.     

9例经口入路机器人手术在口腔颌面外科应用报道

目的: 总结口腔颌面外科机器人手术的应用经验。方法: 解放军总医院口腔科应用达芬奇机器人手术系统对9例位于口腔深部肿瘤患者行经口入路机器人手术（transoral robotic surgery, TORS）,总结手术经验与体会。结果: 患者均顺利完成手术,摆位及术区暴露用时20~90 min,平均42.2 min;手术时间5~90 min,平均40.9 min。除1例双侧颈淋巴清扫术患者外,其余纯口腔入路患者8例,术后平均住院日3.25 d,术后均顺利出院,平均住院天数7.75 d。结论: 达芬奇机器人手术系统可以独立完成口腔深部肿瘤手术,但在特殊患者如舌根肿瘤手术上仍有一定困难,主要是术区暴露时间较长。     

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牙颌面畸形正颌外科治疗需要根据畸形的情况、治疗的要求以及术前患者的生理、心理状态评估综合制定治疗方案.在术前必须对治疗方案、(牙合)关系的调整、骨切开的部位、骨段移动的方向和距离经过精确的设计.正颌外科的术前设计包括头影描迹设计、预测,计算机辅助设计以及模型外科等.本文结合笔者的临床经验和国内外文献对牙颌面畸形正颌外科治疗的术前设计进行述评,强调了牙颌面畸形正颌外科手术方案的设计原则,提出了计算机辅助外科在正颌外科领域具有显著的优势和广阔的应用前景.     

手术机器人系统在颅颌面外科中的应用及发展

近年来机器人辅助外科手术以其微创、精准、安全的特点受到了越来越多的关注。颅颌面外科传统手术严重影响美观。机器人辅助手术延伸了医生的视觉范围和可操作空间,提高了手术效果及患者术后生活质量。本文对手术机器人系统的发展以及近年来在颅颌面外科的应用进行综述。     

正颌外科术后患者的满意度调查

本文通过问卷回顾性地调查了126位正颌外科术后1年以上患者的满意度。93．6%的患者对手术后容貌的改变满意;849%的患者愿意向有类似畸形的亲朋好友推荐正颌外科手术;74.8％的患者愿意再选择手术;64.3％以上的患者术后感觉自信心提高,与他人交往更自如,幸福感增强。     

Psychological issues in oral and maxillofacial reconstructive surgery

Many psychological problems affect patients who have oral and maxillofacial operations. This article reviews these problems among patients with craniofacial conditions, facial injuries, facial cancer, and those having orthognathic surgery. Facial cosmetic surgery is not addressed. Problems such as depression, anxiety, low self-esteem, poor social relationships, and changes in body image are considered. The roles of mental health professionals is emphasised to enhance postoperative satisfaction and to provide a better quality of life for these patients.     

手术导航系统在颅颌面外科的应用

总结术中导航技术的发展历史、基本组成、工作原理和精度影响因素，重点讨论了近年来术中导航技术在颅颌面外科的应用现状，包括神经外科、口腔颌面外科、耳鼻咽喉科、放疗科等。结果显示术中导航将使手术更加个性化，精度更高，更加微创，因而有着良好的应用前景。     

Augmented reality as an aid in maxillofacial surgery: Validation of a wearable system allowing maxillary repositioning

AimWe present a newly designed, localiser-free, head-mounted system featuring augmented reality as an aid to maxillofacial bone surgery, and assess the potential utility of the device by conducting a feasibility study and validation.MethodsOur head-mounted wearable system facilitating augmented surgery was developed as a stand-alone, video-based, see-through device in which the visual features were adapted to facilitate maxillofacial bone surgery. We implement a strategy designed to present augmented reality information to the operating surgeon. LeFort1 osteotomy was chosen as the test procedure. The system is designed to exhibit virtual planning overlaying the details of a real patient. We implemented a method allowing performance of waferless, augmented-reality assisted bone repositioning. In vitro testing was conducted on a physical replica of a human skull, and the augmented reality system was used to perform LeFort1 maxillary repositioning. Surgical accuracy was measured with the aid of an optical navigation system that recorded the coordinates of three reference points (located in anterior, posterior right, and posterior left positions) on the repositioned maxilla. The outcomes were compared with those expected to be achievable in a three-dimensional environment. Data were derived using three levels of surgical planning, of increasing complexity, and for nine different operators with varying levels of surgical skill.ResultsThe mean error was 1.70 ± 0.51 mm. The axial errors were 0.89 ± 0.54 mm on the sagittal axis, 0.60 ± 0.20 mm on the frontal axis, and 1.06 ± 0.40 mm on the craniocaudal axis. The simplest plan was associated with a slightly lower mean error (1.58 ± 0.37 mm) compared with the more complex plans (medium: 1.82 ± 0.71 mm; difficult: 1.70 ± 0.45 mm). The mean error for the anterior reference point was lower (1.33 ± 0.58 mm) than those for both the posterior right (1.72 ± 0.24 mm) and posterior left points (2.05 ± 0.47 mm). No significant difference in terms of error was noticed among operators, despite variations in surgical experience. Feedback from surgeons was acceptable; all tests were completed within 15 min and the tool was considered to be both comfortable and usable in practice.ConclusionWe used a new localiser-free, head-mounted, wearable, stereoscopic, video see-through display to develop a useful strategy affording surgeons access to augmented reality information. Our device appears to be accurate when used to assist in waferless maxillary repositioning. Our results suggest that the method can potentially be extended for use with many surgical procedures on the facial skeleton. Further, our positive results suggest that it would be appropriate to proceed to in vivo testing to assess surgical accuracy under real clinical conditions.     

基于快速原型技术的导航辅助下颌骨内置式牵张成骨术的实验研究

目的：应用自主研发的导航手术系统,在快速原型技术制作的三维头颅模型上进行内置式下颌骨牵张成骨术的实验研究,通过三维定点测量,分析该导航手术的精度。方法：对1例单侧下颌骨发育不足的患者行螺旋CT扫描后,采用快速原型技术制作5个相同的头模,按导航配准原则植入定位钉后再行CT扫描。应用AccuNavi 1.0软件对三维图像进行测量,并与游标卡尺实体测量的相应指标进行头模制作精度检测。然后进行下颌骨三维测量分析与虚拟单侧内置式下颌支牵张成骨术,将制定的手术规划通过实时TBNavis-CMFS导航系统在三维头模上实施,牵引到位后,行CT扫描图像重建,应用AccuNavi1.0软件与Surgicase5.0软件进行三维测量与牵引长轴间成角测量,采用SPSS13.0软件包对结果进行配对t检验。结果：快速原型制作的三维头模与AccuNavi1.0软件重建的三维图像间各测量指标无统计学差异（P〉0.05）。模型手术平均牵引长度12.40mm（11.79～12.68mm）,模拟手术与导航模型术后牵引长轴间成角均值为4.67°（2.01°～6.49°）。导航术后各项指标中,除CoL-CoR（P=0.037）、CoL-GoL（P=0.017）与模拟手术值间有显著性差异外,其余指标间均无显著性差异（P〉0.05）。结论：应用快速原型技术制作的三维头颅模型与AccuNavi1.0软件的三维重建图像精度相仿。通过TBNavis-CMFS导航系统平台,建立了导航辅助下颌骨牵引成骨术的实验方法,准确地将手术规划转移到模型手术中。     

Barcelona line. A multicentre validation study of a facial projection reference in orthognathic surgery

The purpose of this study was to validate an already published facial anteroposterior reference: upper incisor (UI) to soft tissue plane or so-called Barcelona line (BL) to trace the most aesthetic sagittal position of the maxilla. A cross-sectional multicentre evaluation of Caucasian patients from Spain and Brazil with different anteroposterior maxillary positions was designed. Sagittal images in natural head orientation of grouped patients according to the horizontal distance from the UI to BL were ranked by healthcare professionals and non-professional Caucasian raters according to the aesthetic perception of each profile, using a digital survey. Seventy-four raters (50 laypeople, 12 orthodontists, and 12 maxillofacial surgeons) rated 40 profiles. The best-rated profile corresponded to group 3 (0–4 mm UI-BL) with 61.8% of positive evaluations, followed by group 4 (≥ 4 mm UI-BL): with 61.1%. On the other hand, group 1 (≤?4 mm UI-BL) was the worst-ranked profile with 71.8% of negative evaluations, followed by group 2 (?4–0 mm UI-BL): with 59.6% of negative evaluations. The correlation between the mean assessment score and UI-BL showed a moderately-strong association (r = 0.68, p < 0.001). The inter-rater reliability of assessment (74 evaluators) was moderate (k = 0.49, 95% CI: 0.39 to 0.59). The results suggest that protrusive middle-third facial profiles are preferable. The BL is proposed as a simple, individualised, and reproducible tool to trace an aesthetic sagittal position of the maxilla in orthognathic surgery.     

导航手术在颅颌面外科的应用及误差控制

导航手术越来越多地应用于颅颌面种植修复、损伤、面部整复、正颌外科、放疗及射频热凝治疗。精确性是导航手术的关键,误差的控制贯穿于影像获取、配准、实时跟踪及导航手术操作的各个步骤中。本文就颅颌面外科的导航手术应用及误差控制作一综述。     

The use of guided tissue regeneration techniques among endodontists: a web-based survey

Introduction

The purpose of this study was to determine factors and clinical situations that influence an endodontist’s decision to use guided tissue regeneration (GTR) techniques during endodontic root-end surgery.

Methods

An invitation to participate in a web-based survey was e-mailed to 3,750 members of the American Association of Endodontists. Data were collected from 1,129 participants, representing a 30.1% completion rate. The number of questions varied from 3 to 11 depending on individual responses.

Results

40.7% of respondents who perform root-end surgeries also use GTR techniques. The clinical situation in which GTR techniques are used most often is for transosseous lesions. Barrier membranes and bone replacement grafts are each used by more than 85% of respondents using GTR techniques. Insufficient training and insufficient evidence in support of its use were selected as the predominant reasons for not using GTR techniques at 42.4% and 32%, respectively.

Conclusions

Although over 40% of respondents are currently using GTR techniques in conjunction with their root-end surgeries, a majority of those who do not use GTR indicated they would consider using these techniques with better evidence and available training.     

Maxillary stability in patients with skeletal class III malocclusion treated by bimaxillary orthognathic surgery: comparison of mandible-first and maxilla-first approaches in a randomised controlled study

The maxilla-first approach has been the standard orthognathic sequence for many years, however, with the evolution of rigid internal fixation and to eliminate any errors that could be encountered during preoperative bite registration, the mandible-first approach has become an effective treatment modality for bimaxillary orthognathic surgery. Would the maxilla-first or mandible-first orthognathic sequence in bimaxillary orthognathic surgery result in more maxillary stability in patients with skeletal class III malocclusion? Twenty-four patients with skeletal class III malocclusion were selected from the outpatient clinic of the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University. Patients were randomly divided into two equal-sized groups: the maxilla-first approach (group I), and the mandible-first approach (group II). All patients underwent cone-beam computed tomography before, immediately after (P1), and 6 months after surgery (P2). Virtual planning included designing the virtual cuts and the intermediate and final splints. Both splints were three-dimensionally printed. In both approaches, hard and soft tissue landmarks were used as reference points to evaluate maxillary stability, which was calculated by subtracting P2 values from P1 values. All measures were statistically evaluated as numerical values of means and standard deviations. The differences between the radiographic measurements of the two groups were not statistically significant except for the soft tissue inclination at the nasal tip. The mandible-first approach in bimaxillary orthognathic surgery is a reliable method for achieving high maxillary stability.     

牙冠延长术的临床应用

牙冠延长术是近年来临床研究和推广的热门课题。临床上经常遇到因龋病、冠折等原因造成龈上牙体组织过短,给冠修复带来困难;如果冠边缘延伸至龈下过深,侵犯了生物学宽度,则易引起牙周问题。牙冠延长术利用生物学宽度的原理,应用翻瓣术联合牙槽骨修整的方法,延长牙冠或暴露龈下的牙体断端,其重点在于切除牙龈的同时,去除部分牙槽骨,以便在更根方的位置重建健康的牙周组织。