下颌骨缺损的个体化修复重建

目的:探讨下颌骨缺损的个体化修复重建治疗方法。方法:对4例下颌骨肿瘤术后组织缺损的患者,进行个体化的治疗设计。通过多学科合作,进行植骨、种植、义齿修复的综合治疗。结果:4例患者通过个体化的治疗,面形均恢复良好,下颌骨缺损的修复均满足义齿修复的要求。结论:下颌骨缺损的修复应多科合作提供个体化的治疗方案,以义齿修复为导向满足术后义齿修复的需要,最大程度地恢复患者面形及咀嚼功能。     

下颌骨大型缺损的个体化修复

目的探讨下颌骨大型缺损的个体化修复方法。方法选择10例(男、女各5例)华东地区正常牙合汉族成年人,常规拍摄头颅定位正、侧位片。对下颌骨外形线定量相关分析结果做可行性分析;同时为1例下颌骨大型缺损修复提供下颌骨外形线变量数据及下颌骨外侧下弧线形态。结果下颌骨外形线变量实测值与计算值无统计学差异(P>0.05),修复1例下颌骨大型缺损患者,获得良好效果。结论下颌骨外形线相关性分析可为下颌骨大型缺损修复提供依据。     

下颌骨节段性缺损的分类和修复重建

下颌骨位于面部中下1/3,解剖位置和形态特殊,是面部诸多骨骼中唯一可动骨,正常行使功能要求双侧关节联动,功能结构复杂。下颌骨节段性缺损(mandibular segmental defect,MSD)通常是指下颌骨连续性中断的部分下颌骨缺损,多由于良恶性肿瘤切除所致,其它疾病如创伤和感染等也可以导致下颌骨节段性缺损。MSD由于下颌骨连续性的中断,常常导致患者不同程度的有关生理功能障碍和颜面畸形,其修复重建往往既要考虑生理功能的恢复,又要照顾美观功能。随着功能性外科和功能性修复的日益受到关注,如何使下颌骨节段性缺损的修复达到更理想的功能恢复效…     

锶磷灰石修复下颌骨缺损的实验研究

目的　用不同浓度的锶磷灰石 (Sr-HAP)植入动物体内 ,观察该材料的生物学反应 ,为其临床应用作前期研究。方法　将 2 4只新西兰大白兔分为 3组 ,双侧下颌角均造成 6mm× 12mm× 4mm的缺损 ,用不同浓度 ( 10 % ,5 % ,0 % )的含锶羟磷灰石块分别予以修复 ,术后 1月 ,3月 ,6月时随机处死一组分别进行尸解、四环素荧光标记、定量组织学观察以评估其生物性能。结果　锶磷灰石复合人工骨未引起感染和排斥反应 ,术后材料降解早 ,新生骨大量进入材料间隙 ,其成骨量明显较纯羟基磷灰石为多 ,且统计学上有差异 ,5 %的锶磷灰石烧结体内新生骨成熟度较 10 %者为高 ,但统计学上未显示出成骨量的差异 ,术后 3月时锶磷灰石周边出现强而亮的黄色荧光环 ,术后 6月时荧光环仍未消退。结论　 ( 1)锶磷灰石有良好的组织相容性、骨引导性及生物降解性 ,并具有一定程度的骨诱导性。 ( 2 )锶元素浓度并非是影响总成骨量的关键因素 ,总成骨量可能主要与生物降解的程度大小有关。 ( 3)锶的存在不但提高了新骨的总生成量 ,而且延长了新骨生成的总体时间和高峰期     

下颌骨重建术患者的护理体会

目的：探讨下颌骨重建术患者的围手术期护理要点。方法：术前做好术区准备及患者心理护理,术中注意观察患者的生命指征并做好手术配合,术后注意患者的饮食、体位、皮瓣血供及下肢血运的观察。结果：46例骨移植均获成功,未出现1例严重并发症。结论：对下颌骨重建患者要注重术前心理护理及充分的术前准备,并且重视术中配合及术后皮瓣和下肢血供的严密观察。     

下颌骨缺损的修复重建

下颌骨缺损的修复重建对提高患者的生存质量具有重要意义。下颌骨重建的目的不仅仅是为了恢复颌骨的连续性、维持患者正常的容貌形态,而且要恢复患者的咀嚼、吞咽、语言等正常生理功能,达到牙-颌-肌肉-神经反射的协调及功能统一,即功能性重建。本文回顾了下颌骨缺损修复重建的现状和研究进展,包括下颌骨修复重建的原则、常见的下颌骨缺损的修复重建方法、下颌骨功能性重建的若干问题、牵张成骨及组织工程在下颌骨修复重建中的应用等。     

小型猪骨膜成骨修复下颌骨节段性缺损的研究

目的:探讨原位骨膜成骨修复小型猪下颌骨节段性缺损的可行性。方法:选用13个月龄小型猪8只,雌雄不限,拔除右侧下颌前后磨牙3个月后,随机分为保留骨膜组(A组)和不保留骨膜组(B组),每组4只。再按骨缺损长度分为30 mm组和40 mm组,每组各2只。制备小型猪下颌骨体部30 mm和40 mm节段性骨缺损,利用钛板固定两侧骨断端,A组完整保留缺损区颊舌侧的骨膜并将其严密缝合形成一封套层,B组则不保留骨膜,术后4、8、12周进行影像学观察。结果:影像学观察保留骨膜组术后12周完成骨连接,新生骨形态规则,不保留骨膜组未完成骨连接,仅在骨断端有极少量新生骨,且形态不规则。结论:利用骨膜原位成骨可以修复下颌骨较大范围节段性骨缺损。     

下颌骨缺损整复后颞下颌关节的变化

目的 :观察单侧或部分下颌骨缺损重建术后升支高度和下颌骨髁状突运动的变化。材料和方法 :30例患者按手术方式的不同分为两组 ,A组为保留髁状突的下颌骨部分切除、自体骨移植或病变骨冷冻再植整复组 ,B组为未保留髁状突组 ,术后通过X线检查评价结果。结果 :所有患者手术后都表现有不同程度的髁状突运动障碍。主要有升支高度降低、髁状突水平运动和转动能力降低 ,且A、B两组间存在明显差别 ,B组改变大于A组。结论 :下颌骨缺损重建对颞下颌关节结构和功能具有一定的影响 ,保留髁状突时所受影响要明显小于未保留髁状突组。因此保留髁状突有利于获得较好的术后功能效果     

游离腓骨肌(皮)瓣修复下颌骨缺损的临床研究

目的:总结应用游离腓骨肌(皮)瓣修复下颌骨缺损的经验。方法:根据32例患者下颌骨缺损的部位和特征,对腓骨肌瓣进行塑形,重建钛板固定,恢复下颌骨的形态和功能。结果:31例腓骨肌(皮)瓣修复下颌骨缺损患者获得成功,1例失败。结论:游离腓骨肌(皮)瓣是修复下颌骨缺损的一种理想方法。     

Evaluation of Non-vascular Fibula Graft for Mandibular Reconstruction

Introduction

Functional and cosmetic defects in maxillofacial region are caused by various ailments like trauma, neoplasm, developmental, infections and iatrogenic causes. Reconstruction of these defects with free flaps remains the gold standard but demerits like need for surgical expertise and equipment, prolonged duration of surgery, compliance of the patient and increased cost are associated with microvascular reconstruction. Hence reconstruction with nonvascular bone grafts can be considered when defect is nonirradiated and <9 cm and with sufficient soft tissue cover available.

Purpose

To retrospectively evaluate clinical, radiological outcome and complications encountered with mandibular reconstruction using non vascular fibula graft.

Patients and Methods

This retrospective study included 7 patients who were treated in the Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, AP between 2011 and 2013 with histologically proven benign osteolytic lesions of mandible that require a segmental mandibulectomy and primary reconstruction using autogenous non-vascularised fibular graft. The clinical case records of the patients and personal patient assessment forms (Quality of Life Assessment Forms) were analysed. They were recalled every 3rd, 6th and 9th month after surgery for evaluation of clinical, radiological outcome of the graft and complications occurring at recipient and donor sites.

Results

In all the 7 patients, the lower border continuity was maintained except in one where the graft was dislodged. Tongue movements in all the patients were unrestricted. Jaw movements were affected in cases of ramus defects with slight deviation to operated side and reduced mouth opening. Radiological observations revealed no significant changes in 3 months except for slight reduction in graft height. The radioopaque bridging with continuity of lower border of mandible was noticed in 6th month indicating the take of the graft. This was achieved in every case except in one where the graft was lost due to dislodged reconstruction plate. In 9th month the edges of the graft i.e., graft to native mandible junction showed more resorption (3 mm) especially where there is >2 mm of gap. Whereas increase in height of graft in other areas especially in graft to graft junction was seen. Significant graft resorption was seen in two cases. There were no major complications associated with the donor site.

Conclusion

Avascular fibula graft although a second choice to vascularised fibula, is a favourable option for mandible defects of 6–10 cm under optimum conditions especially in developing countries where financial and/or surgical resources are limited. An attempt for primary reconstruction with this is never futile as it prevents aesthetic deformity even in the event of failure and thus makes secondary reconstruction easy. However in order to confirm the results a prospective study with large scale of patients is necessary.

Electronic supplementary material

The online version of this article (doi:10.1007/s12663-014-0657-1) contains supplementary material, which is available to authorized users.