TÍNH CHÍNH XÁC VÀ PHÙ HỢP CỦA HÀM BỊT MÔ PHỎNG TRƯỚC PHẪU THUẬT VÀ HÀM BỊT THỰC TẾ SAU PHẪU THUẬT Ở BỆNH NHÂN SAU PHẪU THUẬT CẮT ĐOẠN BÁN PHẦN XƯƠNG HÀM TRÊN

Abstract

Objective: To evaluate the accuracy and suitability of the pre-surgical simulated obturator and the post-surgical actual obturator in patients undergoing partial maxillectomy. Subjects and Methods: The study was conducted on 20 patients indicated for partial maxillectomy, including (17 cases of IIb, 2 cases of IIc, and 1 case of IId) according to the Brown classification, who underwent pre-surgical obturator fabrication with the support of 3D technology. Patients were re-examined at least 1 month after surgery, and post-surgical obturator scanning was performed. Comparison between the pre-surgical obturator and the obturator at re-examination was conducted using the open-source software Medit Design to assess the accuracy and suitability of the obturator at the two time points. Results: The 3D design method demonstrated good accuracy in the majority of cases, but not perfect and with variation among patients – consistent with the observation that some patients had smooth obturator placement (no adjustments needed), while others required adding or trimming resin. The average deviation (avg mean = -0.025 mm) is close to 0, with a median = 0.0025 mm, indicating that the 3D-designed obturator generally fits well with the remaining tissue immediately after surgery. The dispersion (sd mean = 0.209 mm, RMS = 0.212 mm) is at an acceptable level, but max sd = 0.648 mm and min In tol = 52.83% indicate cases of poor fit (requiring extensive adjustments). This explains why some patients need added resin (to compensate for negative deviations) or trimming (for positive deviations, max mean = 1.839 mm). Conclusion: The pre-surgical fabricated obturator design with 3D technology support is accurate and highly effective (good fit ~87%), helping to reduce discomfort and improve function immediately after surgery. However, it does not achieve absolute accuracy due to the varying degrees of injury in each patient, as well as deviations during the surgical process, leading to the necessity of obturator adjustments in some patients.