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Intraoperative condylar positioning techniques on mandible in orthognathic surgery

机译:正颌手术中下颌骨术中髁突定位技术

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Abstract Purpose The surgical condylar displacement often resulted in relapse and serious symptoms of temporomandibular joint disorders (TMD) after orthognathic surgery. To minimize the displacement, numerous techniques have been proposed. To verify their accuracy in positioning and effectiveness in preventing post‐operative TMD and relapse, we reviewed the literature related to intraoperative condylar positioning techniques on the mandible in this study. Methods The literature on condylar positioning techniques was reviewed with two charts, including the non‐computer‐assisted and the computer‐assisted positioning methods. The pre‐ and post‐operative alterations of condyles, the post‐operative temporomandibular joint (TMJ) function and surgical relapse were analysed regarding the techniques. The clinical usage and characteristics were reviewed as well. Results A total of 22 articles, including 907 patients, have been reported since 2001. Nearly all methods reach a considerable positioning accuracy within the range of 1‐2?mm and 1‐2° from the pre‐operative position. We ranked the accuracy of the methods from high to low: CAD/CAM CPDs > CAD/CAM titanium plate positioning > manual positioning > computer‐assisted navigation systems > imaging positioning systems. Most skeletal class II and class III patients achieved great occlusion and had no TMJ dysfunction or relapse after condylar positioning. Conclusions Both the non‐computer‐assisted and computer‐assisted condylar positioning techniques reach considerable accuracy in locating the pre‐operative condyle position and preventing TMJ dysfunction and surgical relapse. Different levels of surgeons and cases can benefit from multiple suggested positioning methods. Further research with large samples and long‐term follow‐up is worth looking forward to upgrading the current methods, improving the clinical utility and developing new positioning techniques.
机译:摘要 目的 正颌手术后髁突移位常导致颞下颌关节疾病(TMD)复发和严重症状。为了尽量减少位移,已经提出了许多技术。为了验证其定位的准确性和预防术后 TMD 和复发的有效性,我们在本研究中回顾了与术中下颌骨髁突定位技术相关的文献。方法 采用非计算机辅助定位法和计算机辅助定位法两种图表对髁突定位技术文献进行综述。分析了术前和术后髁突改变、术后颞下颌关节(TMJ)功能及手术复发情况。还对临床用法和特点进行了综述。结果 自2001年以来共报道22篇文献,涉及907例患者。几乎所有方法在距术前位置 1-2?mm 和 1-2° 的范围内都能达到相当大的定位精度。我们对方法的精度从高到低进行排序:CAD/CAM CPDs>CAD/CAM钛板定位>手动定位>计算机辅助导航系统>成像定位系统。大多数骨骼II级和III级患者在髁突定位后没有颞下颌关节功能障碍或复发。结论 非计算机辅助和计算机辅助髁突定位技术在术前髁位置定位、预防颞下颌关节功能障碍和手术复发方面均具有较高的准确性。不同级别的外科医生和病例可以从多种建议的定位方法中受益。大样本和长期随访的进一步研究值得期待,以升级现有方法,提高临床实用性并开发新的定位技术。

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