CN113143399A - V-line osteotomy mandibular profilometry positioning template generation method - Google Patents
V-line osteotomy mandibular profilometry positioning template generation method Download PDFInfo
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Abstract
The invention relates to a template manufacturing technology, provides a V-line osteotomy mandible profilometry positioning template generation method for solving the problem that the existing V-line osteotomy mandible profilometry has no special positioning template, and the technical scheme can be summarized as follows: the method comprises the steps of establishing a 3D model of the cranio-maxillofacial bone according to the head of a patient, measuring required mark points in the model, establishing a three-dimensional projection measurement analysis coordinate system, measuring corresponding data of the cranio-maxillofacial bone, designing a bone cutting line in the model according to requirements, simulating bone cutting to obtain a simulated scheme, guiding the simulated scheme in, generating a bone cutting guide plate which is attached to the surface of the regional anatomical morphology through a surface stretching function, extending the bone cutting guide plate to the rear edge of a lifting support, the lower edge of a mandible to the chin, obtaining data of the required bone cutting guide plate, guiding the data in, and obtaining the bone cutting guide plate through rapid prototyping and a 3D printing technology. The method has the advantages that the osteotomy guide plate for the patient can be conveniently and quickly generated, and the method is suitable for generating the V-line osteotomy mandibular profilometry positioning template.
Description
Technical Field
The invention relates to a template manufacturing technology, in particular to a positioning template manufacturing technology for mandibular branch, mandibular angle and mandibular inferior margin osteotomy (namely V-line osteotomy mandibular contour forming).
Background
Quite a lot of serious patients with hypertrophic mandibular angle (quadrate jaw) belong to the low-angle quadrate jaw, i.e. the opening degree of the mandibular angle is less than 120 degrees or approximately in a right angle, the plane angle of the mandible is less than 20 degrees or even reaches 0 degree, the curve of the lower edge of the mandible is too gentle, or the contour of the lower edge of the mandible drops unsmoothly. The ideal reshaping effect is difficult to obtain by applying traditional techniques such as mandibular angle osteotomy or mandibular angle area bone outer plate osteotomy due to the problems that the mandibular plane angle cannot be effectively increased, the mandibular opening degree is too small, the position of the newly formed mandibular angle is accurately positioned, the radian of the mandibular outline is controlled and the like. In recent years, the east asian region has increasingly been advocated with "melon seed face" or "heart face" due to the influence of fashion and media factors. To achieve the purpose, an effective operation method is adopted for patients with large mandibular angle (quadrate jaw) to solve the problem of small mandibular plane angle, increase the opening degree of the mandibular angle, gradually lift the mandibular lower edge backwards and upwards, make the curve steep, reposition the mandibular angle, and reshape the radian of the mandibular outline to obtain a more dexterous and sharp lower facial outline. Therefore, aiming at the contour characteristics of patients with hypertrophic mandibular angle (square jaw) and different appearance characteristics and aesthetic requirements of beauty-seeking people, a mandibular angle and mandibular border osteotomy (V-line osteotomy mandibular border angioplasty) is applied by an oral approach to correct the low-angle square jaw, so as to achieve the beauty effects of accurately remodeling the mandibular angle position, changing the mandibular border and chin contour, increasing the mandibular angle opening degree and mandibular plane angle to remodel the mandibular border contour line, and steepening the originally excessively gentle mandibular border to achieve the beauty effects of melon seed face, heart-shaped face or goose egg face.
The V-line osteotomy mandibular profilometry has the following operation steps: firstly, a 1% lidocaine solution containing 1/100000 adrenaline is locally infiltrated and injected, the mucous membrane is cut from the front edge of the mandibular ascending branch, the flat maxillary occlusal plane along the external oblique line and forwards to the 6mm part of the gingival vestibular groove near the labial side of the central incisor, the mucous membrane is directly reached to the periosteum, a periosteal stripper is used for stripping off the mandibular ascending branch, the mandibular angle, the mandibular body and the chin to the complete mandibular lower margin, the sleeve is stripped off, and the mental neurovascular bundle is properly dissociated and properly protected. The same operation is performed on the side rows, and then the operation area is completely exposed. The design of the bone cutting line starts from a mandibular angle point (1.5-2.5 cm below the ear drop) newly positioned at the rear edge of the ascending support, goes over the mandibular angle, the mandibular edge and the lower jaw opening to the lower part of the root tip of the chin canine, the mandibular angle newly formed after the cutting is formed by intersecting the rear edge of the mandibular support and the mandibular edge cutting line, the distance from the mandibular angle to the ear drop is usually 1.5cm-2.5cm in aesthetic people, and the front end of the cutting line adjusts the position of the lower jaw edge according to whether the mandibular edge and the chin are too wide. The incision line is positioned above 3mm below the inferior alveolar neurovascular tube in the whole course, so as to avoid injury to cause numbness feeling in the postoperative lower lip region and massive bleeding in the operation, therefore, a mandible image on an X-ray film is carefully studied before an operation, a bone incision line is generally designed 3mm below two side mental orifices, the inclination degree of the incision line and the curvature of the curve are determined according to the amplitude of a mandible plane angle required to be adjusted before the operation, the curve is a section of arc, and the arc center is positioned at the nasal root point. Special attention is needed to protect the mental nerve during operation. The mandibular branch, the mandibular angle and the mandibular lower edge are hooked and exposed by the Shea's light guide drag hook or the water absorbing general drag hook, the reciprocating saw is used to cut the bone cutting line from the chin to the mandibular angle to the trailing edge of the ascending branch according to the designed bone cutting line under the running of the mandibular nerve tube, and the bone is cut to the deep part along the cut bone sulcus after the positioning until the lingual side bone plate is completely cut. When the operation is carried out, fingers are placed at the mucous membrane of the lower jaw and tongue side to sense the cutting depth, once the tongue side bone plate is cut completely, an experienced doctor can saw the whole course of complete bone cutting, and can also sense that the bone block is cut fully, after the bone block has sufficient activity, a thin-edge curved bone knife is inserted into a bone cutting gap, the bone cutting position is slightly pried to be bone connection, and the whole layer of mandibular angle and the lower jaw edge in the area are cut off. The inner alar muscle attachment and mandibular hyoid muscle attachment were cut off with an electric knife or dissector, and the cut bone pieces were fully freed and removed intact. After the bilateral resection is completed, whether the angle of the mandible and the margin of the mandible are smooth or not is touched, if a little bone spur exists, the mandible is carefully trimmed and removed, the wound is washed by normal saline, the wound in the mouth is sutured after hemostasis is properly performed, a negative pressure drainage tube is placed, and the mouth is externally pressed and bound.
The V-line osteotomy mandibular contouring technique, pioneered in 2009 by the applicant, has the advantages of aesthetic design of the mandibular contour as an integral aesthetic unit, contour remodeling from the mandibular rise to the chin, larger osteotomy range, ability to reposition the newly formed mandibular angle, effective improvement of the jaw angle opening and mandibular plane angle, and more harmonious and natural mandibular contour, however, it also puts higher demands on the experience and aesthetics of the operator as it has a longer osteotomy line and a larger osteotomy range than conventional mandibular angle osteotomy. Due to the restriction of the operative field and the visual angle of the operator, even an experienced operator has difficulty in achieving perfect bilateral mandibular border symmetry osteotomy. On the basis, the mandible contour change of a patient is accurately analyzed and predicted and the V-line osteotomy line is determined before an operation by manufacturing a positioning template of the V-line osteotomy mandible contour forming operation, and continuous symmetrical osteotomy of the mandible angle and the mandible lower edge is accurately performed in the operation, so that the phenomenon that the mandible contour is not coordinated after the operation due to insufficient experience of an operator or limited field of vision in the operation is avoided, but no special positioning template for the V-line osteotomy mandible contour forming operation exists at present.
Disclosure of Invention
The invention aims to solve the problem that the existing V-line osteotomy mandibular profilometry has no special positioning template, and provides a V-line osteotomy mandibular profilometry positioning template generation method.
The technical scheme adopted by the invention for solving the technical problems is that the V-line osteotomy mandibular profilometry positioning template generation method comprises the following steps:
step 2, measuring required mark points in the established 3D model positioning data, establishing a three-dimensional projection measurement analysis coordinate system, and measuring corresponding data of the cranio-maxillofacial bone in the three-dimensional projection measurement analysis coordinate system;
step 3, designing an osteotomy line of the V-line osteotomy mandibular contour arthroplasty in the established 3D model according to requirements, and carrying out simulated osteotomy to obtain a simulated scheme;
step 4, importing a simulated scheme, designing a bone cutting guide plate, generating the bone cutting guide plate which is attached to the anatomical morphology surface of the cut bone in the simulated bone cutting scheme through a surface stretching function, and extending the bone cutting guide plate to the rear edge of the lifting support and the lower edge of the lower jaw until the chin part to obtain the required data of the bone cutting guide plate;
and 5, importing data of the osteotomy guide plate, and obtaining the osteotomy guide plate through a rapid prototype and a 3D printing technology, wherein the osteotomy guide plate is a V-line osteotomy mandibular profilometry positioning template.
Specifically, in order to explain the parameter requirements during CT examination, in step 1, when the helical CT examination is performed on the head of the patient, the parameters of the CT examination are as follows: the matrix size is 512 multiplied by 512, the layer thickness is less than or equal to 1.0mm, the layer distance is equal to the layer thickness, the reconstruction algorithm is High resolution standard algorithm, the gantry tilt angle is 0 degrees, and the export file format is DICOM.
Further, to describe the method for importing CT data to build a 3D model of the maxillofacial bone in detail, in step 1, the importing CT data to build the 3D model of the maxillofacial bone means: and importing the obtained CT data into Mimics or Dolphin software to establish a 3D model of the maxillofacial bone.
Specifically, in order to provide a method for establishing a 3D model of the maxillofacial bone by using the mimis software, in step 1, the step of importing the obtained CT data into the mimis software to establish the 3D model of the maxillofacial bone specifically includes: and (3) importing CT data, three-dimensionally reconstructing jaw bone data and facial soft tissues by using a segment module in the Mimics software, and reconstructing lower alveolar nerves by using a create nerve function.
Further, to specify the mark points required for measurement in the established 3D model positioning data and establish the three-dimensional projection measurement analysis coordinate system, in step 2, the mark points required for measurement in the established 3D model positioning data and the establishment of the three-dimensional projection measurement analysis coordinate system refer to: and measuring a nasal root point and a sphenoid saddle point in the established 3D model positioning data, taking the nasal root point as an original point, selecting a plane parallel to the Frankfurt plane through the nasal root point on a horizontal plane, selecting a plane perpendicular to the Frankfurt plane through the nasal root point and the sphenoid saddle point on a middle sagittal plane, and selecting a plane perpendicular to the Frankfurt plane and the middle sagittal plane through the nasal root point on a coronal plane.
Specifically, in order to specify the cranio-maxillofacial bone data, in step 2, the cranio-maxillofacial bone data includes a mandibular plane angle, a bilateral mandibular angle opening degree, and a lifting height.
Further, in order to provide a method for simulating osteotomy by using the Mimics software, in step 3, the method for designing an osteotomy line for mandibular angle osteotomy in the established 3D model according to the requirement and simulating osteotomy includes: simulating a unilateral mandibular angle resection scheme, repositioning a new mandibular angle point, mandibular angle opening degree and mandibular plane angle, positioning an osteotomy line below a mandibular nerve tube by less than 5mm, simulating osteotomy with a cutting plane function in the Mimics software according to the designed osteotomy line, mirroring the osteotomy line to the opposite side according to the mid-sagittal plane standard, and simulating osteotomy with the cutting plane function in the Mimics software.
Specifically, to describe the method for designing the osteotomy guide plate in detail and to provide a suitable thickness of the osteotomy guide plate, in step 4, the step of introducing the simulated solution is as follows: importing the simulated scheme into 3-matic software; the surface stretching function is a function carried by software; in the osteotomy guide plate which is generated and is jointed with the surface of the anatomical feature of the osteotomy in the simulated osteotomy scheme, the thickness of the osteotomy guide plate is 1-3 mm.
Further, to illustrate the introduction of the osteotomy guide data, in step 5, the introduction of the osteotomy guide data is: the osteotomy guide plate data is introduced into the CAM machine after line conversion.
Specifically, for making things convenient for the later stage to detect the cut bone baffle that makes, then in step 5, when leading-in cut bone baffle data, still lead-in cranio-maxillofacial bone corresponding data, select corresponding mandible data from it, when obtaining the cut bone baffle through rapid prototyping and 3D printing technique, still obtain patient's mandible model through rapid prototyping and 3D printing technique.
The V-line osteotomy mandibular profilometry positioning template generation method has the beneficial effects that the osteotomy guide plate of a patient can be conveniently and quickly generated by the V-line osteotomy mandibular profilometry positioning template generation method, continuous symmetrical osteotomy of the mandibular angle and the mandibular lower edge can be accurately performed through the osteotomy guide plate during actual operation, and after CT modeling of a postoperative shooting patient is used, fitting comparison is performed with a preoperative simulation osteotomy scheme, so that the accuracy of mandibular angle osteotomy performed by template navigation designed and manufactured by the method is found to be good. Effectively avoids the incongruity of the lower jaw contour after the operation caused by insufficient experience of operators or limited field of vision during the operation.
Drawings
Fig. 1 is a flow chart of the method of creating a mandibular inferior border osteotomy positioning template of the present invention.
FIG. 2 is a schematic view of the osteotomy guide and patient mandible model generated by the present invention.
Wherein, 1 is a bone cutting guide plate, and 2 is a mandible model of a patient.
Detailed Description
The technical solution of the present invention is described in detail below with reference to the embodiments and the accompanying drawings.
The method for generating the positioning template for the mandibular inferior border osteotomy comprises the following steps, with reference to the flow chart of the method shown in figure 1:
To describe the parameter requirements during CT examination, in this step, when performing the spiral CT examination on the head of the patient, the parameters for the CT examination are preferably: the matrix size is 512 multiplied by 512, the layer thickness is less than or equal to 1.0mm, the layer distance is equal to the layer thickness, the reconstruction algorithm is High resolution standard algorithm, the gantry tilt angle is 0 degrees, and the export file format is DICOM. To explain the method for importing CT data to build a 3D model of a maxillofacial bone in detail, in this step, importing CT data to build a 3D model of a maxillofacial bone may specifically be: and importing the obtained CT data into Mimics or Dolphin software to establish a 3D model of the maxillofacial bone. Taking the Mimics software as an example, in this step, importing the obtained CT data into the Mimics software to establish a 3D model of the maxillofacial bone specifically includes: and (3) importing CT data, three-dimensionally reconstructing jaw bone data and facial soft tissues by using a segment module in the Mimics software, and reconstructing lower alveolar nerves by using a create nerve function.
And 2, measuring required mark points in the established 3D model positioning data, establishing a three-dimensional projection measurement analysis coordinate system, and measuring corresponding data of the cranio-maxillofacial bone in the three-dimensional projection measurement analysis coordinate system.
To specify the mark points required for measurement in the established 3D model positioning data and to establish the three-dimensional projection measurement analysis coordinate system, in this step, the mark points required for measurement in the established 3D model positioning data and the three-dimensional projection measurement analysis coordinate system may be: and measuring a nasal root point and a sphenoid saddle point in the established 3D model positioning data, taking the nasal root point as an original point, selecting a plane parallel to the Frankfurt plane through the nasal root point on a horizontal plane, selecting a plane perpendicular to the Frankfurt plane through the nasal root point and the sphenoid saddle point on a middle sagittal plane, and selecting a plane perpendicular to the Frankfurt plane and the middle sagittal plane through the nasal root point on a coronal plane. To explain the cranio-maxillofacial bone data in detail, the cranio-maxillofacial bone data at least includes the mandibular plane angle, the bilateral mandibular angle opening degree, the ascending support height, etc.
And 3, designing an osteotomy line of the V-line osteotomy mandibular contour arthroplasty in the established 3D model according to requirements, and carrying out simulated osteotomy to obtain a simulated scheme.
Taking the example of simulation of osteotomy by using the micis software, in this step, the osteotomy line of the V-line osteotomy mandibular profilometry is designed in the established 3D model according to the requirements, and the method for simulating osteotomy may specifically be: simulating a unilateral mandibular angle resection scheme, repositioning a new mandibular angle point, mandibular angle opening degree and mandibular plane angle, positioning an osteotomy line below a mandibular nerve tube by less than 5mm, simulating osteotomy with a cutting plane function in the Mimics software according to the designed osteotomy line, mirroring the osteotomy line to the opposite side according to the mid-sagittal plane standard, and simulating osteotomy with the cutting plane function in the Mimics software.
And 4, importing the simulated scheme, designing the osteotomy guide plate, generating the osteotomy guide plate which is attached to the anatomical morphology surface of the osteotomy in the simulated osteotomy scheme through a surface stretching function, and extending the osteotomy guide plate to the rear edge of the ascending support and the lower edge of the lower jaw until the chin part to obtain the required osteotomy guide plate data.
To elaborate the method of designing the osteotomy guide and to give a suitable thickness of the osteotomy guide, in this step, the preferred approach of introducing the simulated version is: importing the simulated scheme into 3-matic software; and the surface stretching function is the self-carried function of the software. The thickness of the osteotomy guide plate, which is to be fitted to the anatomical surface of the osteotomy to be performed in the simulated osteotomy protocol, may be 1-3mm, preferably 2.5 mm.
And 5, importing data of the osteotomy guide plate, and obtaining the osteotomy guide plate 1 through rapid prototyping and 3D printing technology, wherein the osteotomy guide plate is a V-line osteotomy mandibular profilometry positioning template.
To describe the introduction of the osteotomy guide data, in this step, the introduction of the osteotomy guide data is preferably: the osteotomy guide plate data is introduced into the CAM machine after line conversion. For the convenience later stage to the cutting bone baffle that makes detect, then in this step, when leading-in cutting bone baffle data, still lead-in cranio-maxillofacial bone corresponding data, select corresponding mandible data from it, when obtaining cutting bone baffle 1 through rapid prototyping and 3D printing technique, still obtain patient's mandible model 2 through rapid prototyping and 3D printing technique, cut bone baffle and patient's mandible model schematic diagram see figure 2. Like this, owing to made patient's mandible model 2 simultaneously, then available patient's mandible model 2 carries out maintenance and size detection to cutting bone baffle 1, and the position of laying and whether have obvious slip when the purpose that detects is for better simulation use, uses in the convenient operation.
Claims (10)
- A V-line osteotomy mandibular profilometry positioning template generation method comprising the steps of:step 1, performing spiral CT examination on the head of a patient to obtain CT data, and importing the CT data to establish a 3D model of a craniomaxillofacial bone;step 2, measuring required mark points in the established 3D model positioning data, establishing a three-dimensional projection measurement analysis coordinate system, and measuring corresponding data of the cranio-maxillofacial bone in the three-dimensional projection measurement analysis coordinate system;step 3, designing an osteotomy line of the V-line osteotomy mandibular contour arthroplasty in the established 3D model according to requirements, and carrying out simulated osteotomy to obtain a simulated scheme;step 4, importing a simulated scheme, designing a bone cutting guide plate, generating the bone cutting guide plate which is attached to the anatomical morphology surface of the cut bone in the simulated bone cutting scheme through a surface stretching function, and extending the bone cutting guide plate to the rear edge of the lifting support and the lower edge of the lower jaw until the chin part to obtain the required data of the bone cutting guide plate;and 5, importing data of the osteotomy guide plate, and obtaining the osteotomy guide plate through a rapid prototype and a 3D printing technology, wherein the osteotomy guide plate is a V-line osteotomy mandibular profilometry positioning template.
- 2. The V-line osteotomy mandibular profilometry positioning template generating method of claim 1, wherein in step 1, when performing the helical CT examination of the patient's head, the CT examination parameters are: the matrix size is 512 multiplied by 512, the layer thickness is less than or equal to 1.0mm, the layer distance is equal to the layer thickness, the reconstruction algorithm is High resolution standard algorithm, the gantry tilt angle is 0 degrees, and the export file format is DICOM.
- 3. The V-line osteotomy mandibular profilometry positioning template generation method of claim 2, wherein in step 1, said importing CT data to create a 3D model of the maxillofacial bone is: and importing the obtained CT data into Mimics or Dolphin software to establish a 3D model of the maxillofacial bone.
- 4. The V-line osteotomy mandibular profilometry positioning template generating method of claim 3, wherein in step 1, importing the obtained CT data into a mics software to build a 3D model of the maxillofacial bone specifically: and (3) importing CT data, three-dimensionally reconstructing jaw bone data and facial soft tissues by using a segment module in the Mimics software, and reconstructing lower alveolar nerves by using a create nerve function.
- 5. The V-line osteotomy mandibular profilometry positioning template generating method of claim 4, wherein in step 2, said measuring the desired landmark points in the established 3D model positioning data and establishing a three-dimensional projective survey analysis coordinate system means: and measuring a nasal root point and a sphenoid saddle point in the established 3D model positioning data, taking the nasal root point as an original point, selecting a plane parallel to the Frankfurt plane through the nasal root point on a horizontal plane, selecting a plane perpendicular to the Frankfurt plane through the nasal root point and the sphenoid saddle point on a middle sagittal plane, and selecting a plane perpendicular to the Frankfurt plane and the middle sagittal plane through the nasal root point on a coronal plane.
- 6. The V-line osteotomy mandibular profilometry localization template generation method of claim 5, wherein in step 2, said cranio-maxillofacial bone correspondence data comprises mandibular plane angle, bilateral mandibular angle opening and elevation height.
- 7. The V-line osteotomy mandibular profilometry positioning template generating method of claim 6, wherein in step 3, said designing the osteotomy line of the V-line osteotomy mandibular profilometry in the created 3D model as required and performing the simulated osteotomy comprises: simulating a unilateral mandibular angle resection scheme, repositioning a new mandibular angle point, mandibular angle opening degree and mandibular plane angle, positioning an osteotomy line below a mandibular nerve tube by less than 5mm, simulating osteotomy with a cutting plane function in the Mimics software according to the designed osteotomy line, mirroring the osteotomy line to the opposite side according to the mid-sagittal plane standard, and simulating osteotomy with the cutting plane function in the Mimics software.
- 8. The V-line osteotomy mandibular profilometry positioning template generation method of claim 1, wherein in step 4, said introducing a simulated protocol is: importing the simulated scheme into 3-matic software; in the osteotomy guide plate which is generated and is jointed with the surface of the anatomical feature of the osteotomy in the simulated osteotomy scheme, the thickness of the osteotomy guide plate is 1-3 mm.
- 9. The V-line osteotomy mandibular profilometry positioning template generation method of claim 1, wherein in step 5, said importing osteotomy guide data is: the osteotomy guide plate data is introduced into the CAM machine after line conversion.
- 10. The V-line osteotomy mandibular profilometry positioning template generating method of any one of claims 1 to 9, wherein in step 5, when the osteotomy guide data is imported, the cranio-maxillofacial bone corresponding data is also imported, the corresponding mandible data is selected therefrom, and when the osteotomy guide is obtained by rapid prototyping and 3D printing techniques, the mandible model of the patient is also obtained by rapid prototyping and 3D printing techniques.
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