對於下顎骨發生缺損的病患，整形外科醫師通常會使用腓骨游離皮瓣來進行重建，為了重塑下顎骨原有的外觀，我們需要將腓骨切割成不同長度的片段，組合成近似下顎曲線的外觀。而考慮骨骼癒合的速度，能夠建立緊密的骨間吻合面是相當合理的要求。因此，如何建構一個良好的手術計畫與提供可靠的工具來協助骨骼切割是非常重要的。下顎骨重建手術的成功關鍵在於，能夠提供手術者一套可靠而正確的方法，將下顎骨缺損的空間資訊傳遞到腓骨上，以便讓他們做為切割腓骨的參考。關於這個問題先前有許多學者提出解決方案，然而並沒有一個簡便而好用的方法。 為了提供更好的手術結果，我們發展出兩種方法，以增加鋸骨手術的準確度。我們使用電腦輔助設計技術，來製作出一組外型類似病患下顎骨的紙質模型，並利用此模型讓醫師做良好的切割路徑規劃。而以此為根據，我們更研發出一套金屬材質的機械裝置，來幫助醫師在手術中準確的量測下顎骨缺損的空間資訊，並協助進行精準的腓骨鋸切。在臨床方面，紙質模型方法已經應用於六位病患，而機械裝置則應用於十二位病患的重建。在這些病患上我們都可以得到良好的骨與骨的接觸吻合面。在進一步的應用方面則包括兩種情況：第一種是使用客製化的咬合板與機械裝置，以便選擇腓骨長度與切割斜面，來決定適當的下顎植牙位置，第二種是合併使用紙質模型與機械裝置，來協助進行非立即性的下顎骨重建手術。在本研究中，我們提出了紙質模型與機械裝置兩種創新的方式，來協助下顎骨重建手術中切割腓骨的步驟。在不同的狀況下，這兩種方法可以分別應用或是合併使用，以得到最好的手術結果。 ;For patients with intraoral defects which involve the mandible, plastic surgeons often use free fibular flaps for reconstructions. To restore the native curvature of the mandible, the fibula bone has to be cut into different sized segments. Considering the speed of bone healing, it is reasonable that good bone-to-bone contact will improve bone union. Therefore, a comprehensive plan and a stable guide for osteotomies are essential. The key to a successful mandibular reconstruction is to accurately and properly transmit the spatial information of mandible defect to the fibula. Different methods have been proposed; however, better solutions are still needed. To improve the surgical outcome we tried to develop two methods for increasing the accuracy of fibula osteotomies. We used computer-aided design technology to produce a paper model which is similar to the shape of patient’s mandible, and used the model as reference for performing fibula osteotomies. This method then inspired us about the formation of metallic mechanical device(s) to help surgeons intraoperatively measure the mandible defect, design the ideal shape of fibula bone flap and perform precise osteotomies. The paper model method was applied in 6 patients and the mechanical device method was used for the reconstruction of 12 patients. Well matched bone-to-bone contact surfaces were achieved in these patients. Further applications of these methods may include: the combination these two methods together for secondary mandibular reconstructions and the use of mechanical device(s) with custom-made surgical stent for optimize the ideal lengths and beveling angles of bone segments. In this study we present the development and use of two novel fibula osteotomy guides, paper model and mechanical device, for mandibular reconstructions. Under different circumstances, these two methods can be utilized separately or combined together for the best surgical results.
