目的:本研究调查了下颌骨重建手术中由于髁突在颞下颌关节中定位不当而导致的不令人满意的结果。还提出了重建后髁突定位不满的系统分类方法。
方法:对337例肿瘤切除和下颌骨血管化皮瓣重建患者进行回顾性分析。重建技术包括常规手术(43.3%)和3D技术指导程序(56.7%)。评估利用术前和术后CT扫描来评估矢状(S)和冠状(C)平面中的下颌垂直支长度(V)和con突对齐。因此,开发了髁突定位分类系统,缩写为VSC。它包括四个类:I类,适当的髁突重建;二级,短支长度;III类,矢状/冠状髁位置的一个或两个方面不满意;和IV类,两三个方面的不满。
结果:髁突重建总成功率为85.16%。虽然没有统计学意义,3D辅助组的成功率(85.86%)略高于常规组(84.25%).就VSC分类而言,案件在第一类中的分布,II,III,和IV分别为287、4、9和37例,分别。值得注意的是,髁突脱位与缺损部位显著相关,特别是身体和髁(p<0.001,OR=49.734,95%CI12.995-190.342),和重建段的数量(p=0.025,OR=3.480,95%CI1.173-10.328)。
结论:研究结果强调了准确重建方法的重要性,并揭示了髁突脱位中缺损部位和重建节段数量的含义。因此,我们提出了一个分类系统,以完善髁突定位评估,提高下颌骨重建的手术效果。
OBJECTIVE: This study investigates the unsatisfactory outcomes observed in mandibular reconstruction procedures attributed to improper condylar positioning in the Temporomandibular Joint. It also proposes a systematic classification for post-reconstruction condylar positioning dissatisfaction.
METHODS: A retrospective analysis was conducted on 337 patients who underwent tumor removal and mandibular reconstruction with vascularized osteocutaneous flaps. Reconstruction techniques included conventional surgery (43.3%) and 3D technology-guided procedures (56.7%). Evaluation utilized preoperative and postoperative CT scans to assess mandibular vertical ramus length (V) and condylar alignment in both sagittal (S) and coronal (C) planes. Accordingly, a classification system for condylar positioning was developed and abbreviated as VSC. It includes four classes: Class I, proper condylar reconstruction; Class II, short ramus length; Class III, one or two aspects of sagittal/coronal condylar positions dissatisfaction; and Class IV, two or three aspects dissatisfaction.
RESULTS: The overall success rate for condylar reconstruction was 85.16%. Though not statistically significant, the success rate was marginally higher in the 3D-assisted group (85.86%) compared to the conventional group (84.25%). In terms of the VSC classification, the distribution of cases across Class I, II, III, and IV were 287, 4, 9, and 37 cases, respectively. Notably, condylar dislocation was significantly associated with the defect site, particularly the body and condyle (p < 0.001, OR = 49.734, 95% CI 12.995-190.342), and the number of reconstructed segments (p = 0.025, OR = 3.480, 95% CI 1.173-10.328).
CONCLUSIONS: The findings highlight the importance of accurate reconstruction methods and reveal implications of the defect site and the number of reconstructed segments in condylar dislocation. Consequently, we propose a classification system to refine condylar positioning assessment and enhance surgical outcomes in mandibular reconstruction.