| Objective:1.To discuss the application of digital technology in the clinical effect of distraction osteogenesis to treat hemifacial microsomia.2.To discuss the effect of distraction osteogenesis to treat hemifacial microsomia and to compare its facial symmetry with that of normal people with aid of digital technology.3.To measure and analyze changes of bone tissues before and after the two methods distraction osteogenesis treatment for hemifacial microsomia,and to compare the result of operation quantitatively of the two treatment methods with aid of digital technology.Methods:Selecte cases of 18 pationts with hemifacial microsomia treated at the Department of Maxillofacial Plastic Surgery,Plastic Surgery Hospital Chinese Academy of Medical Sciences from January 2013 to May 2017 for this study.Among which 9 pationts(Group C)were treated with the intraoral internal distraction osteogenesis with gittal split ramus osteonomy,the other 9 pationts(Group D)were treated with the extraoral internal distraction osteogenesis.According to enter criterions,we selected 14 case(Group A)from above 18 case and other 21 case(Group B)of people were normal.To compare the facial symmetry of hemifacial microsomia with that of normal people with aid of digital technology.1.After the the CT data and three-dimensional facial scanning data of hemifacial microsomia patients were input into ProPlan to establish the three-dimensional coordinate system for measuring bone tissues,the anatomical landmarks would be marked to conduct accurate quantitative analysis of both side of face.Further,the morphological characteristics of facial asymmetry deformity would be discussed and the method for preoperative evaluation would be assured.2.Before the surgery,three-dimensional CT data were used to reconstruct bone tissues models.We marked the location of inferior alveolar neurovascular bundle and dental germs,on the basis of which an accurate operation design for osteotomy would be worked out.The distances and directions of distraction according to the asymmetry of the affected and unaffected sides will also be planned.9 pationts were treated with the intraoral internal distraction osteogenesis with gittal split ramus osteonomy,the other 9 pationts were treated with extraoral internal distraction osteogenesis.After surgery,the traction would be applied to lengthen the mandible and improve facial asymmetry.3.We used the three-dimensional measurement method to conduct pre-postoperative and nomal people’s comparative analysis of hemifacial microsomia patients,and calculated the changes of facial symmetrical indexes.Besides,We quantitatively analyzed the improvement of asymmetry of bone tissues in hemifacial microsomia patients who have undergone the two different distraction osteogenesis.Results:1.The application of digital technology in the treatment for hemiafacial microsomia can improve the patients’ clinical effect and evaluate it more conviniently.2.The facial asymmetry of mandibula,maxilla and chin was significantly improved compared with pre-operation in group of hemifacial microsomia(p<0.05),while the same indexes after operation in group of hemifacial microsomia still had significantly difference compared with that in group of normal people(p<0.05).3.The facial asymmetry was significantly improved in both groups compared with pre-operation.The length of mandibular ramus in group C and group D were both significantly improved compared pre-operation(p<0.05),while the group D was better than group C(p<0.05).The thickness of mandibular ramus were both significantly improved compared pre-operation(p<0.05),but there was no statistical significance between two groups(p>0.05).The width of mandibular ramus in group C was no significantly improved(p>0.05),while in Group D,the width of mandibular ramus become smaller compared pre-operation(p<0.05).The distance from chin point to facial midline were significantly improved both in the two group(p<0.05).Conclusions:1.The application of digital technology in the treatment and evaluation of hemifacial microsomia can improve the accuracy of surgery and analyze the the facial symmetry quantitatively.2.The facial asymmetry of HFM was significantly improved after the operation of distraction osteogenesis,while the facial symmetry of HFM still have difference compared with normal people.3.The facial asymmetry of hemifacial microsomia was significantly improved through the two methods of distraction osteogenesis,while the method of intraoral internal modified distraction osteogenesis has advantage in maintaining the width of mandibular ramus and the method of intraoral internal distraction osteogenesis has adwantages in extenning the length of mandibular ramus.Therefore,to acquire the best clinical effect,surgeons shoud select the suitable method according the acuity of patients with hemifacial microsomia. |
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