Accuracy of virtual surgical planning-assisted management for maxillary hypoplasia in adult patients with cleft lip and palate.
- 作者列表："Wang Y","Li J","Xu Y","Huang N","Shi B","Li J
PURPOSE:Management of maxillary hypoplasia in patients with cleft lip and palate (CLP) remains a significant clinical challenge. The objective of this retrospective study is to evaluate the accuracy of virtual surgical planning (VSP) with different maxillary advancement techniques. METHODS:Ninety adult patients with cleft-related maxillary hypoplasia between April 2010 and April 2016 were enrolled in our study. Various surgical techniques including conventional orthognathic surgery, total maxillary distraction osteogenesis, and anterior maxillary segmental distraction were used according to the characteristics of patients. All the cases were aided with VSP and three-dimensional (3D)-printed surgical splints. The virtual surgical plan was compared with the postoperative surgical results by analyzing the positions of several landmarks and planes relative to reference planes. RESULTS:Both the profile and occlusion were improved significantly in all the cases. VSP was successfully transferred to actual surgery with the help of 3D-printed surgical splints in different surgical techniques. CONCLUSION:Management of cleft-related maxillary hypoplasia requires both comprehensive surgical planning and accurate execution. VSP serves as a viable alternative to conventional model surgery with high accuracy in patients with adult CLP.
目的: 唇腭裂 (CLP) 患者上颌骨发育不全的治疗仍然是一个重大的临床挑战。本回顾性研究的目的是评估不同上颌推进技术的虚拟手术计划 (VSP) 的准确性。 方法: 2010 年 4 月至 2016 年 4 月间，90 例成人上颌骨裂相关发育不全患者入选本研究。根据患者特点采用各种手术技术，包括常规正颌手术、全上颌牵张成骨、上颌前段牵张成骨。所有病例均采用VSP和 3D打印手术夹板辅助治疗。通过分析几个地标和平面相对于参考平面的位置，将虚拟手术计划与术后手术结果进行比较。 结果: 所有病例的侧貌和咬合均有明显改善。在不同手术技术的 3d打印手术夹板的帮助下，VSP成功转移到实际手术中。 结论: 唇裂相关的上颌骨发育不全的治疗既需要全面的手术计划，也需要准确的执行。VSP是成人CLP患者高准确性常规模型手术的可行替代方案。
METHODS::Impairments in social cognition have been frequently described in 22q11.2 deletion syndrome (22q11.2DS) and are thought to be a hallmark of difficulties in social interactions. The present study addresses aspects that are critical for everyday social cognitive functioning but have received little attention so far. Sixteen children with 22q11.2DS and 22 controls completed 1 task of facial expression recognition, 1 task of attribution of facial expressions to faceless characters involved in visually presented social interactions, and 1 task of attribution of facial expressions to characters involved in aurally presented dialogues. All three tasks have in common to involve processing of emotions. All participants also completed two tasks of attention and two tasks of visual spatial perception, and their parents completed some scales regarding behavioural problems of their children. Patients performed worse than controls in all three tasks of emotion processing, and even worse in the second and third tasks. However, they performed above chance level in all three tasks, and the results were independent of IQ, age and gender. The analysis of error patterns suggests that patients tend to coarsely categorize situations as either attractive or repulsive and also that they have difficulties in differentiating emotions that are associated with threats. An isolated association between the tasks of emotion and behaviour was found, showing that the more frequently patients with 22q11.2DS perceive happiness where there is not, the less they exhibit aggressive behaviour.
METHODS:BACKGROUND:We describe the first radiographic clinic in the literature for DDH and how this novel clinic can significantly improve the efficiency and cost-effectiveness of service in a tertiary referral centre. AIMS:A radiographic clinic for the management of developmental dysplasia of the hip was introduced in 2017 in our institution. We performed a detailed cost analysis to assess the economic savings made with the introduction of this new clinic. We assessed the efficiency of the service by identifying how many unnecessary outpatient visits were prevented. We also assessed the difference in times from referral to review between the two clinics. METHODS:Analysis of the clinic activity in 2017 was possible as all data was collected prospectively by the DDH CNS and stored in our database. Cost analysis was performed, and the savings made per patient along with the financial benefit to our institution was recorded. RESULTS:The new radiographic clinic reduced the cost of reviewing one patient by €162.51 per patient. There was a 73% discharge rate from the clinic which prevented 251 unnecessary patient visits to the outpatient department over the course of the year. There was a significant 11-day reduction in waiting times between referral and review when comparing the radiographic to the conventional clinic (p < 0.05). CONCLUSIONS:A radiographic clinic for the management of developmental dysplasia of the hip has a significant effect on the efficiency and overall cost-effectiveness of service provision in a tertiary referral centre.
METHODS:INTRODUCTION:Triple pelvic osteotomy (TPO) involves periacetabular osteotomies of the ilium, ischium, and pubis to reorient the acetabulum. This operation is indicated in certain situations for the treatment of developmental dysplasia of the hip, dysplastic neuromuscular hips, and for containment of the femoral head in cases of Legg-Calvé-Perthes disease. METHODS:This retrospective cohort study compares radiographic outcomes of patients who underwent TPO using two different techniques and describes a novel single-incision direct lateral approach. TPO was performed on 22 patients by the senior author. The first 10 patients underwent TPO through a single-incision anterolateral approach. The last 12 patients underwent TPO using the direct lateral approach. Preoperative and postoperative pelvic radiographs were reviewed for each patient, and the migration index and center-edge angle were recorded. RESULTS:The migration index and center-edge angle were evaluated and were not found to be significantly different between the anterolateral and direct lateral groups. The direct lateral approach is described. CONCLUSION:The direct lateral approach for TPO is equivalent to the anterolateral approach on radiographic evaluation. Advantages of the direct lateral approach include direct visualization of the ischial osteotomy, effective mobilization of the acetabulum, and safety of the sciatic nerve.