本研究调查了由于颞下颌关节髁突定位不当而导致的下颌重建手术中观察到的不令人满意的结果。并对重建后髁突定位不满意提出了系统的分类。对337例接受肿瘤切除并带血管骨皮瓣重建下颌的患者进行回顾性分析。重建技术包括传统手术（43.3%）和3D技术引导手术（56.7%）。评估利用术前和术后 CT 扫描来评估下颌垂直升支长度 (V) 和矢状面 (S) 和冠状面 (C) 平面的髁突对齐情况。据此，开发了髁突定位分类系统并缩写为VSC。它包括四类：I类，适当髁重建； II级，短支长度； III级，矢状/冠状髁突位置某一或两方面不满意； Ⅲ级，两三个方面不满意。髁突重建总体成功率为85.16%。尽管没有统计学意义，但 3D 辅助组的成功率 (85.86%) 略高于传统组 (84.25%)。在VSC分类方面，I、II、III、IV类病例分布分别为287例、4例、9例和37例。值得注意的是，髁脱位与缺损部位显着相关，特别是体部和髁部（p < 0.001，OR = 49.734，95% CI 12.995-190.342），以及重建节段的数量（p = 0.025，OR = 3.480，95） % CI 1.173-10.328）。研究结果强调了准确重建方法的重要性，并揭示了髁突脱位缺损部位和重建节段数量的影响。因此，我们提出了一个分类系统来完善髁突定位评估并提高下颌重建的手术效果。© 2024 Wiley periodicals LLC。

This study investigates the unsatisfactory outcomes observed in mandibular reconstruction procedures attributed to improper condylar positioning in the Temporomandibular Joint. It also proposes a systematic classification for post-reconstruction condylar positioning dissatisfaction.A retrospective analysis was conducted on 337 patients who underwent tumor removal and mandibular reconstruction with vascularized osteocutaneous flaps. Reconstruction techniques included conventional surgery (43.3%) and 3D technology-guided procedures (56.7%). Evaluation utilized preoperative and postoperative CT scans to assess mandibular vertical ramus length (V) and condylar alignment in both sagittal (S) and coronal (C) planes. Accordingly, a classification system for condylar positioning was developed and abbreviated as VSC. It includes four classes: Class I, proper condylar reconstruction; Class II, short ramus length; Class III, one or two aspects of sagittal/coronal condylar positions dissatisfaction; and Class IV, two or three aspects dissatisfaction.The overall success rate for condylar reconstruction was 85.16%. Though not statistically significant, the success rate was marginally higher in the 3D-assisted group (85.86%) compared to the conventional group (84.25%). In terms of the VSC classification, the distribution of cases across Class I, II, III, and IV were 287, 4, 9, and 37 cases, respectively. Notably, condylar dislocation was significantly associated with the defect site, particularly the body and condyle (p < 0.001, OR = 49.734, 95% CI 12.995-190.342), and the number of reconstructed segments (p = 0.025, OR = 3.480, 95% CI 1.173-10.328).The findings highlight the importance of accurate reconstruction methods and reveal implications of the defect site and the number of reconstructed segments in condylar dislocation. Consequently, we propose a classification system to refine condylar positioning assessment and enhance surgical outcomes in mandibular reconstruction.© 2024 Wiley Periodicals LLC.