The Effect Of Reconstruction Of Mandibular Fibula With Different Models

ObjectiveTo study the curative effects and differences of the three different computer-aided design models to reconstruct mandibular with fibula.Methods43 patients were selected from the department of oral and maxillofacial surgery in Provincial Hospital Affiliated to Shandong University from 2005 to 2010. And the cases were divided into three experimental groups and respectively treated by three different computer-aided design models to reconstruct mandibular with fibula. The index or parameters (such as face, mouth opening, mouth type, mandibular symmetry, occlusion, Fricton index of temporomandibular disorders and the image and other conventional clinical parameters) were observed and recorded respectively in preoperative and postoperative(six months following-up after operation). At last, the data from each experimental group were statistically analyzed by the SAS software.Results:Facial symmetry evaluation of the positive view:In group one, the up, middle, down 3 1/3 scale of face were all coordinated, double mandibular angle was in the same plane, the upper and lower lips cover relations were harmonious, and surplus tooth occlusal was normal in patients of preoperative and postoperative. The indexes were not statistically significant. In group two, the up, middle, down 3 1/3 scale of face were all also coordinated, the lips covered normal, and surplus tooth occlusal was normal. The indexes were not statistically significant in patients of preoperative and postoperative. However, double jaw angle with plane indicators are statistically significant in this group. In group three, the up, middle, down 3 1/3 scale of face were all coordinated, double mandibular angle was in the same plane, the upper and lower lips cover relations were harmonious, and surplus tooth occlusal was normal in patients of preoperative and postoperative. The indexes were also not statistically significant. And the indexes, such as the 3 1/3 scale of face, double mandibular angle plane, the lips cover relation and surplus tooth occlusal, also showed no significant difference among three experimental groups in patients of postoperative.Zu-Bing Li etc grading standards:three groups all reached the fine standard in postoperative. There was no statistically significant among three experimental groups in patients of postoperative.Temporomandibular joint (TMJ) evaluation:In group one, mouth-opening degree (≥35mm), midline deviation (≥1mm), and temporomandibular joint symptoms in patients of preoperative and postoperative showed no significant difference. In group two, mouth-opening degree (≥35mm), midline deviation (≥mm), and temporomandibular joint symptoms in patients of preoperative and postoperative showed no significant difference. In group three, mouth-opening degree (≥35mm), midline deviation (≥1mm), and temporomandibular joint symptoms in patients of preoperative and postoperative showed no significant difference. And the indicators, such as mouth-opening degree (≥35mm), midline deviation (≥1mm), and temporomandibular joint symptoms, were also not statistically different among three experimental groups.Imaging evaluation:All the cases in three groups bone healing were good, and healing rate were all 100%. There was no statistical difference among three experimental groups.Patient satisfaction evaluation:In group one, the indexes (appearance, diet and speech) in patients of preoperative and postoperative showed no significant difference. In group two, the indexes of diet and speech in patients of preoperative and postoperative showed no significant difference. But appearance indexes were statistically significant in this group. In group three, the indexes (appearance, diet and speech) in patients of preoperative and postoperative showed no significant difference. And the indexes (appearance, diet and speech) showed no significant difference among three experimental groups.Fricton index of temporomandibular disorders evaluation:In each group of the three, the indexes (DI, PI and CMI) in patients of preoperative and postoperative showed no significant difference. And the indexes (DI, PI and CMI) showed no significant difference among three experimental groups yet.ConclusionClinical examination shows that the patients in three experimental groups all gain good mouth-opening degree, opening type and remaining tooth occlusion. Imaging shows that the patients in three experimental groups all get normal mandible appearance and good bone healing. Fricton index of TMJ disorders demonstrates that the mandibular joint function is well restored. Although the three models are different, there is no obvious statistical significance in therapy effects among three experimental groups.