对侧下颌骨外板夹心植骨矫正咬合关系正常的面下部不对称  

Contralateral mandibular outer cortex "sandwich" bone grafting for correcting lower facial asymmetry with normal occlusal relationship

作　　者：吴国平[1] 卢通 曲禹铭 高升 谢知洋 闫凯丽 乔宠旭 闫顺超 王树 上官文松 Wu Guoping;Lu Tong;Qu Yuming;Gao Sheng;Xie Zhiyang;Yan Kaili;Qiao Chongxu;Yan Shunchao;Wang Shu;Shangguan Wensong(Department of Plastic Surgery,the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学友谊整形外科医院整形外科,南京210029

出　　处：《中华整形外科杂志》2024年第10期1049-1058,共10页Chinese Journal of Plastic Surgery

摘　　要：目的探讨自体下颌骨外板夹心移植扩展下颌骨矫正咬合关系正常的面下部不对称的临床效果。方法回顾性分析2016年1月至2019年12月南京医科大学友谊整形外科医院整形外科收治的面下部不对称患者的临床资料。术前行颌面部锥形束CT(CBCT)扫描,获取颌面骨骼三维数据,采用计算机辅助设计下颌骨外板的截骨范围和截骨导板。按截骨导板截取供区侧(较大侧)下颌骨外板,将截取的下颌骨外板节段性分割后,按受区侧下颌骨外板弧度夹心移植固定于受区下颌骨外板内侧,增加下颌骨厚度。于术后7 d和术后6个月随访,进行颌面部CBCT扫描,通过调查患者对面形满意度评分(1~5分,分值越高表示满意度越高),测量下颌升支高度(Co-Go)、下颌骨体部长度(Go-Me)、下颌骨外板厚度和体积变化,对手术效果进行评估。采用SPSS 12.0软件进行统计学分析,术前和术后6个月患者对面形满意度评分比较采用配对t检验,术前、术后7 d、术后6个月的Co-Go和Go-Me比较采用重复测量方差分析,若差异有统计学意义,则进一步采用事后检验(Tukey’s HSD检验)对数据进行分析。结果共纳入16例面下部不对称畸形患者,男5例,女11例,年龄18~40岁,平均25.2岁。手术方式:取较大侧下颌骨外板夹心移植到对侧扩展下颌9例,在外板夹心移植同时行颏部截骨成形术7例。随访6个月~5年,平均18.6个月,所有患者术后均出现下唇麻木,均于6个月内恢复,无严重并发症发生;所有患者的面下部轮廓形态对称性得到明显改善,且维持良好。患者对面形满意度评分术前为(1.63±0.62)分,术后6个月提高到(4.19±0.75)分,差异有统计学意义(P<0.01)。供区侧Co-Go和受区侧Go-Me在术前、术后7 d、术后6个月的差异无统计学意义(P均>0.05);供区侧Go-Me和受区侧Co-Go在3个时间点的差异有统计学意义(P均<0.05)。在供区侧,术后7 d下颌骨外板厚度最大减小6 mm,术ObjectiveTo investigate the clinical outcomes of using autologous mandibular outer cortex"sandwich"grafting to augment mandible for correcting lower facial asymmetry with normal occlusal relationships.MethodsA retrospective analysis was conducted on the clinical data of patients with lower facial asymmetry treated at the Department of Plastic Surgery,the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University,from January 2016 to December 2019.Preoperative cone-beam CT(CBCT)scans of the maxillofacial region were obtained to acquire three-dimensional data of the maxillofacial skeleton.Computer-aided design was used to determine the osteotomy range of the mandibular outer cortex and design osteotomy guide template.The outer cortex of the larger mandibular side(donor site)was harvested according to the osteotomy guide template and sectioned.The segmented mandibular outer cortex was then contoured to match the arc of the recipient side’s mandibular outer cortex and fixed to the inner side of the recipient mandibular outer cortex,thus increasing the width and thickness of the expanded mandible.Follow-up was conducted at 7th day and 6 months postoperatively,CBCT scan was performed to measure the changes in ramus height(Co-Go),mandibular body length(Go-Me),and mandibular outer cortex thickness,and volume,and the patient satisfaction with facial appearance(1 to 5 points,with higher scores indicating higher satisfaction),were assessed to evaluate surgical outcomes.Statistical analysis was performed using SPSS 12.0 software.Paired t-tests were used to compare patient satisfaction scores preoperatively and six months postoperatively.Repeated measurement ANOVA was used to compare Co-Go and Go-Me measurements preoperatively,7th day,and 6 months postoperatively.If a statistically significant difference is found,further analysis using post-hoc testing(Tukey’s HSD test)will be conducted to examine the data.ResultsSixteen patients with lower facial asymmetry were included,comprising of 5 males and 11 fema

关 键 词：面部不对称 下颌骨 外板 截骨术 夹心植骨 

分 类 号：R782.2[医药卫生—口腔医学]