| Objective1.Using digital technology to measure the anatomical landmarks and three-dimensional evaluation indexes of head modeling in patients with hypertelorism,analyze the three-dimensional morphological characteristics,and clarify the deformity characteristics,so as to provide the basis for the selection of treatment stratege.2.To explore the systematic application of digital technology and three-dimensional cutting guides in the correction of hypertelorism.3.To explore the indications and advantages of inverted U-shaped periorbital osteotomy based on digital technology in correcting hypertelorism.4.Analyze the accuracy of digital simulation and 3D printing cutting guides in the correction of hypertelorism,and to enrich the theoretical basis for the application of digital technology.Methods1.A total of 15 patients with congenital hypertelorism were selected from June 2013 to August 2019 in Maxillofacial Plastic Center,Plastic Surgery Hospital,Chinese Academy of Medical Sciences.They were divided into midface cleft hypertelorism group(Group A)and unilateral coronal craniosynostosis group(Group B)according to the etiology.With the help of digital technology,a new three-dimensional coordinate system was established to measure the related anatomical landmarks and three-dimensional evaluation indexes of patients with hypertelorism.2.From June 2013 to August 2019,8 children with congenital hypertelorism diagnosed and received surgical treatment in maxillofacial plastic surgery center of Plastic Surgery Hospital of Chinese Academy of Medical Sciences were selected.Among them,there were 4 patients with hypertelorism caused by unilateral coronal craniosynostosis and 4 patients were midface cleft hypertelorism.The digital technology system was applied to the design of surgical plan,preoperative simulation,osteotomy guided by 3D printing cutting guides,preoperative deformity and quantitative evaluation of postoperative effect.3.From January 2015 to December 2019,4 children with hypertelorism caused by unilateral coronal craniosynostosis in Maxillofacial Plastic Center of Plastic Surgery Hospital of Chinese Academy of Medical Sciences were selected,and inverted U-shaped osteotomy(an modified osteotomy method)through combined intracranial and extracranial approaches was performed to correct hypertelorism,and the surgical results were observed and summarized.4.From January 2015 to December 2019,6 children with congenital hypertelorism who were treated in maxillofacial plastic surgery center of plastic surgery hospital of Chinese academy of medical sciences and operated with digital simulation and 3D printing cutting guides were selected.the data of IOD,ICD and FNA were measured quantitatively,and the accuracy of digital technology was statistically analyzed.Results1.In group A,the distance from the medial orbital wall to the median sagittal plane is statistically different on both sides,and the lateral orbital diameter on both sides is also statistically different.The innermost point of orbital medial wall and the outermost point of orbital lateral wall have statistical differences on both sides in coronal direction.Bilateral optic nerve angle increased obviously,but there was no statistical difference.The mean value of ACVAI was 1.44%,and there was no significant difference between the sphenoid angle of the anterior cranial fossa.In group B,the distance from the medial orbital wall to the median sagittal plane was significantly different on both sides,and the lateral orbital diameter was also significantly different on both sides The longitudinal diameter is significantly different on both sides.The longitudinal diameter on the affected side is larger than that on the opposite side,and the optic nerve angle on both sides is also significantly increased.The highest point of supraorbital wall has statistical differences in coronal direction,sagittal direction and vertical direction The outermost point of orbital lateral wall has statistical difference in sagittal direction and vertical direction;There are statistical differences in the medial orbital wall mainly in the coronal direction;The mean ACVAI was 16.07%,the affected side of sphenoid angle of anterior cranial fossa was 53.15°,and the healthy side was 66.08°.2.Using digital technology to make the operation plan and 3D printing osteotomy guide plate to guide osteotomy can shorten the osteotomy time to 1-2 hours without any complications.In unilateral coronal craniosynostosis group,IOD,ICD and ACVAI decreased from 33.20mm to 23.98mm,46.83mm to 37.00mm and 16.07%to 1.74%respectively,which were significantly different from those before operation.The average cranial cavity volume increased from 1179.62ml to 1241.57ml,an increase of 5.3%compared with that before operation,with significant difference compared with that before operation.The mean orbital cavity volume of the affected side increased from 18.57ml to 22.90ml,which was 23.3%higher than that before operation,and that of the healthy side increased from 21.70ml to 23.65ml,which was 9.0%higher than that before operation.In midface cleft hypertelorism group,IOD and ICD decreased from 30.15mm to 19.83mm and 50.23mm to 37.48mm respectively,which were significantly different from those before operation.From the coordinate changes of anatomical landmarks,the difference of three-dimensional coordinates of landmarks on both sides of the two groups became smaller.3.The 4 cases were successfully operated according to the digital design plan,the osteotomy time was shortened to 2-3 h,the average blood loss was 970ml,and the average hospitalization time was 10 days.There were no complications such as cerebrospinal fluid leakage,infection,intracranial hematoma and eyeball injury.After operation,the shape of the head and orbit of the patients were greatly improved,and the exotropia of the patients was improved.The interorbital distance decreased to normal range.4.The average IOD of patients before operation is 35.1mm,the designed IOD is 23.9mm,and the actual IOD after operation is 23.4 mm.There is no statistical difference between the designed IOD before operation and the actual IOD after operation.The average ICD of patients before operation is 50.5mm,the designed ICD before operation is 40.7mm,and the actual ICD after operation is 43.6 mm.There is statistical difference between the designed ICD before operation and the actual ICD after operation.The average FNA of patients before operation is 168.4°,and the actual FNA after operation is 148.5°.There is statistical difference between preoperative and postoperative FNA.Color temperature diagram showed that the surgical simulated effect was consistent with the actual effect after surgery to a great extent.Conclusion1.A new three-dimensional measurement coordinate system is established to quantitatively evaluate the morphological characteristics of hypertelorism.The deformity characteristics of midface cleft hypertelorism are mainly manifested in the asymmetric expansion of double orbits in the coronal direction;The deformity of hypertelorism caused by unilateral coronal craniosynostosis is characterized by asymmetric outward expansion of bilateral orbitals in coronal direction,and asymmetric deformity in sagittal and vertical directions,showing that the orbital diameter of the affected side narrows laterally,lengthens longitudinally,and the whole orbit inclines upward and backward.2.Applying digital technology to the whole process of preoperative design,intraoperative osteotomy and postoperative evaluation of hypertelorism correction can shorten the operation time,improve the accuracy of osteotomy,quantitatively evaluate the postoperative effect and cranio-orbital development function.3.Inverted U-shaped osteotomy is suitable for patients with hypertelorism whose orbital upper edges are not at the same level,especially those with coronal craniosynostosis and hypertelorism.Its advantages are less surgical trauma,shorter operation time and better correction effect.4.Digital technology has high accuracy in surgical simulating,designing cutting guides,which can ensure the accurate implementation of surgical design during operation.It can provide theoretical basis for further application of digital technology. |
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