数字化外科技术在上颌骨缺损重建中的应用

上颌骨是面中份结构的基石，毗邻口腔、鼻腔、上颌窦及眼眶，参与上颌 眶 颧骨复合体等重要的面中份结构的组成。由于肿瘤、外伤或先天性畸形造成的上颌骨缺损，不仅严重影响患者外形，而且直接导致患者的语音、咀嚼、吞咽等生理功能障碍，严重影响患者的生活质量。由于上颌骨及面中份解剖结构的复杂性，使得上颌骨缺损的修复与重建一直是临床医生面临的难题［1］。1999年以来，本课题组在国内率先开展应用游离组织瓣功能性重建上颌骨缺损的系统研究，提出游离腓骨瓣功能性重建上颌骨缺损的临床应用方法、适应证及围手术期处理原则。同时，通过三维有限元分析探讨腓骨瓣重建上颌骨缺损的生物力学基础，对患者术后的语音功能、咀嚼功能、生存质量及供区并发症等进行了系统的分析评价，客观反映了该方法良好的临床治疗效果，提高了上颌骨缺损修复重建的临床治疗水平［2-7］。

Surgical reconstruction of maxillary defects using computer-assisted techniques

The maxilla is the most important bony support of the mid-face skeleton and is critical for both esthetics and function.Maxillary defects,resulting from tumor resection,can cause severe functional and cosmetic deformities.Furthermore,maxillary reconstruction presents a great challenge for oral and maxillofacial surgeons.Nowadays,vascularized composite bone flap transfer has been widely used for functional maxillary reconstruction.In the last decade,we have performed a comprehensive research on functional maxillary reconstruction with free fibula flap and reported excellent functional and acceptable esthetic results.However,this experience based clinical procedure still remainssome problems in accuracy and efficiency.In recent years,computer assisted techniques are now widely used in oral and maxillofacial surgery.We have performed a series of study on maxillary reconstruction with computer assisted techniques.The computer assisted techniques used for maxillary reconstruction mainly include:(1) Three dimensional (3 D) reconstruction and tumor mapping:providing a 3 D view of maxillary tumor and adjacent structures and helping to make the diagnosis of maxillary tumor accurate and objective;(2) Virtual planning:simulating tumor resection and maxillectomy as well as fibula reconstruction on the computer,so that to make an ideal surgical plan;(3) 3D printing:producing a 3D stereo model for prebending individualized titanium mesh and also providing template or cutting guide for the surgery;(4) Surgical navigation:the bridge between virtual plan and real surgery,confirming the virtual plan during the surgery and guarantee the accuracy;(5) Computer assisted analyzing and evaluating:making a quantitative and objective of the final result and evaluating the outcome.We also performed a series of studies to evaluate the application of computer assisted techniques used for maxillary reconstruction,including:(1)3D tumor mapping technique for accurate diagnosis and treatment of maxillary tumor;(2) Maxillary reconstruction with free fibula flap used computer assisted techniques;(3) Computer assisted orbital floor reconstruction after maxillectomy.The results suggested that computer assisted techniques could significantly improve the clinical outcome of maxillary reconstruction.