- 期刊
以即時導航輔助方式植入顴骨植體－病例報告
Real-Time Navigation Assisted Zygomaitc Implant Placement-A Case Report
摘要
近幾年來，顴骨植體對於在上顎骨極度缺損的重建治療越來越被臨床所使用。目前顴骨植牙的手術方式，主要以手術導板輔助徒手手術為主，少數文獻提出一些使用內視鏡輔助或是即時導航輔助方式來完成。顴骨植牙手術，需要充分了解顴骨的解剖構造，因為植體的稍微偏離顴骨都可能造成嚴重的手術併發症，例如眼眶骨破損造成斜視、失明、出血等。手術導板對於這類上顎骨嚴重缺損的病患來說不易固定位置，容易造成植體鑽孔入徑偏斜，所以大多需要臨床醫師暴露大範圍的顴骨區以及熟練的臨床經驗來確定。本篇提出一名33歲男性病患，因長期牙周不良造成上下顎骨極度萎縮，與病患討論後，決定接受上顎以兩支顴骨植體合併前牙兩隻植體與下顎以四支植體，作為全口重建方式。在使用即時導航輔助的方式下，手術中可以即時調整顴骨植體鑽孔的位置與方向，在避免傷及眼窩或是顳下窩造成併發症的前提下，增加植體與顴骨較多的接觸面積，並且減少對於手術區的暴露，術後病惠的眼眶下腫脹與瘀血現象也較傳統方式減少，根據我們所回顧文獻，此病例應用即時導航輔助方式植入顴骨植體為台灣第一例，故提出此方式作為臨床參考。
並列摘要
Zygomatic implants for rehabilitating severe bony atrophy in the maxilla have been increasingly used in recent years. Zygomatic implant placement starts with initial surgical stent assisted and ends with freehand technique for implant axis confirmation. In addition, only a few studies have proposed that zygomatic implant placement with the endoscope or real-time navigation systems assisted may shed the surgical complications. It is necessary to comprehensively understand the surrounding anatomical structure of the zygomatic area, because a slight deviation of the implant fixture from the zygomatic bone may cause serious surgical complications such as strabismus, blindness, bleeding, which may be caused by orbital cavity damage. Also, surgical stents are not easy to be stabilized in the jaw bone which is severe atrophy. Failing to control initial axis of implants may cause the implant deviating from the ideal drilling path in this situation. Therefore, this is a surigcal sensitive procedure and required to expose a large surgical field of the zygomatic area. This article demostrated a 33-year-old man with extreme bimaxillary atrophy due to chronic periodontal disease. After discussing with the patient, he decided to accept the upper jaw with two zygomatic implants over posterior maxilla and two conventional implants over premaxilla and the lower jaw with four Implants as a full mouth rehabilitation. Assisted with real-time navigation systems, surgeons could confirm the bone to implant contact (BIC) in real-time and could decrease the intra-operative complications such as the perforation of orbital cavity or internal bleeding in infra-temporal space. In addition, the position and direction of the zygomatic implant can be adjusted immediately during the surgical procedure. Moreover, placement zygomatic implants with navigation assisted also could decrease postoperative orbital swelling and ecchymosis in patients through limited exposure of the surgical field. According to the literatures we reviewed, our case is the first case in Taiwan with the real-time surgical navigation assisted for zygomatic implantation in severe atrophy maxillary rehabilitation, we proposed this case as a clinical reference.