下颌骨重建术

下颌骨缺损特别是大型的下颌骨缺损给患者造成极大的生理和心理障碍,严重威胁患者的生存质量,重建缺损下颌骨解剖外形、生理功能是近一个世纪来在本领域中具有挑战性的课题。     

颞下颌关节重建术

为了探讨颞下颌关节真性强直的外科治疗,解决术后易复发的难题,作者近十年来采用自体肋骨游离移植和／或下颌骨长支后缘纵截倒置,对３８例颞下颌关节真性强直患者进行了关节重建术,术后随访,测量张口度,计算出随诊时张口度减术前张口度的差值,检查咬Ｈｅ关系,下颌前伸和侧向运动功能,并通过关节开闭品 Ｘ线片来分析观察关节间从而综合评价手术治疗效果。结果发现,３７例患者术后张口度的差值在２．０ｃｍ以上,咬Ｈｅ关系     

Mandibular Reconstruction: Overview

Introduction

Mandibular reconstruction has changed significantly over the years and continues to evolve with the introduction of newer technologies and techniques.

Purpose

This article reviews the history of oromandibular reconstruction, biomechanics of mandible, summarizes the reconstruction options available for mandible with defect classification, goals in reconstruction, the various donor sites, current reconstructive options, dental rehabilitation and persistent associated problems.

Summary

Oromandibular reconstruction, although a challenge for the head and neck reconstructive surgeon, is now reliable and highly successful with excellent long-term functional and aesthetic outcomes with the use of autogenous bone grafts and current reconstructive options. The ideal reconstruction would provide a solid arch to articulate with the upper jaw, restoring swallowing speech, mastication, and esthetics. Autogenous vascularized bone grafts in combination with microsurgical techniques have revolutionized mandibular reconstruction in oral cancer surgery. Current trends in mandibular reconstruction aim to achieve reestablishment of a viable mandible of proper form and maxillary mandibular relationship while decreasing the need for invasive autogenous graft procurement. However the optimal reconstruction of mandibular defects is still controversial in regards to reconstructive options which include the donor site selection, timing of surgery and method of reconstruction.

     

Reconstruction of the nasal alar

The authors of this study describe a case of nasal alar deformity with a congenital deficiency of cartilage treated with a rotation flap. To choose the reconstruction technique, reference parameters such as the age of the patient, the presence of preexisting scars, and the size of the defect are assessed by focusing on the tissue structure and on the major aesthetic demands of the younger patients. Good aesthetic results, with an acceptable cicatricial outcome and an excellent morphofunctional reconstruction of the ala, were achieved in the treated subject. The postoperative course was also good with no complications.