PDF(Pubmed)
Abstract：
OBJECTIVE: Compromised swallowing, speaking, and local complications are the major disadvantages of established approaches to the posterior tongue and oropharynx. The mandibular split involves an esthetically unpleasant bipartition of the lower lip and is prone to bony non-union or sequestration. The conventional pull-through technique on the other hand lacks the secure reattachment of the lingually released soft tissues.
METHODS: The feasibility of a new modified pull-through approach was tested on three anatomical specimens. CAD/CAM cutting guides were used to design a retentive bone flap to properly refixate the genioglossus and geniohyoid muscles after the procedure. The radiographic assessment and treatment planning was performed on 12 cadavers. The entire procedure was tested surgically via dissection in three of those cases. This procedure was then applied in a clinical case.
RESULTS: Precise repositioning and dynamic compression of bony segments was possible reproducibly and without injury to adjacent structures. In all dissected cases, a median lingual foramen was found and in two cases vessels entering it could be dissected Radiologic anatomical landmarks were sufficient in all 12 cases to perform the clinical planning procedure. Clinically, the osteotomized segment demonstrated good blood supply and plateless repositioning was verified postoperatively via cone beam scan.
CONCLUSIONS: The method presented is safe and easy to perform. Individual cutting guides improve the safety and accuracy of the procedure, potentially eliminating the need for osteosynthesis. We provide the anatomical and radiologic basis for clinical evaluation of this pedicled bone flap procedure and present the clinical application of this modified pull-through approach.
METHODS: The feasibility of a new modified pull-through approach was tested on three anatomical specimens. CAD/CAM cutting guides were used to design a retentive bone flap to properly refixate the genioglossus and geniohyoid muscles after the procedure. The radiographic assessment and treatment planning was performed on 12 cadavers. The entire procedure was tested surgically via dissection in three of those cases. This procedure was then applied in a clinical case.
RESULTS: Precise repositioning and dynamic compression of bony segments was possible reproducibly and without injury to adjacent structures. In all dissected cases, a median lingual foramen was found and in two cases vessels entering it could be dissected Radiologic anatomical landmarks were sufficient in all 12 cases to perform the clinical planning procedure. Clinically, the osteotomized segment demonstrated good blood supply and plateless repositioning was verified postoperatively via cone beam scan.
CONCLUSIONS: The method presented is safe and easy to perform. Individual cutting guides improve the safety and accuracy of the procedure, potentially eliminating the need for osteosynthesis. We provide the anatomical and radiologic basis for clinical evaluation of this pedicled bone flap procedure and present the clinical application of this modified pull-through approach.
摘要：
目的：吞咽困难，说话,和局部并发症是已建立的后舌和口咽入路的主要缺点。下颌分裂涉及下唇的美学上令人不快的两分，并且容易发生骨性不愈合或隔离。另一方面,常规的拉穿技术缺乏舌状释放的软组织的安全再附着。
方法：在三个解剖标本上测试了一种新的改良的拉穿方法的可行性。CAD/CAM切割导向器用于设计可保持的骨瓣，以在手术后正确地重新固定the肌和the肌。对12具尸体进行了影像学评估和治疗计划。在其中三种情况下，通过解剖对整个过程进行了手术测试。然后将该程序应用于临床病例。
结果：骨段的精确重新定位和动态压缩是可能的，并且不会对相邻结构造成伤害。在所有解剖的病例中，发现舌中孔,在2例病例中,进入该孔的血管可以被解剖。在所有12例病例中,放射学解剖标志足以执行临床计划程序.临床上,截骨段表现出良好的血液供应，术后通过锥形束扫描证实了无平板的重新定位。
结论：提出的方法安全且易于执行。单独的切割指南提高了程序的安全性和准确性，潜在地消除了骨合成的需要。我们为这种带蒂骨瓣手术的临床评估提供了解剖学和放射学基础，并介绍了这种改良的拉穿方法的临床应用。
方法：在三个解剖标本上测试了一种新的改良的拉穿方法的可行性。CAD/CAM切割导向器用于设计可保持的骨瓣，以在手术后正确地重新固定the肌和the肌。对12具尸体进行了影像学评估和治疗计划。在其中三种情况下，通过解剖对整个过程进行了手术测试。然后将该程序应用于临床病例。
结果：骨段的精确重新定位和动态压缩是可能的，并且不会对相邻结构造成伤害。在所有解剖的病例中，发现舌中孔,在2例病例中,进入该孔的血管可以被解剖。在所有12例病例中,放射学解剖标志足以执行临床计划程序.临床上,截骨段表现出良好的血液供应，术后通过锥形束扫描证实了无平板的重新定位。
结论：提出的方法安全且易于执行。单独的切割指南提高了程序的安全性和准确性，潜在地消除了骨合成的需要。我们为这种带蒂骨瓣手术的临床评估提供了解剖学和放射学基础，并介绍了这种改良的拉穿方法的临床应用。
