下颌骨放射性骨坏死伴颌面部组织坏死的临床治疗

目的：探讨较大范围放射性下颌骨骨坏死伴颊瘘的临床手术治疗及下颌骨、面部软组织缺损的修复方法。方法：5例较大范围放射性下颌骨骨坏死，均存在暴露的坏死骨组织和颊瘘，进行下颌骨部分切除和颊部软组织切除，面部组织缺损同期应用腓骨瓣联合前臂皮瓣进行修复。下颌骨缺损平均长度65mm。结果：手术后移植的骨瓣、皮瓣成活，创口Ⅰ期愈合，面部形态及口腔功能恢复。6～12个月复查骨愈合趋正常，未见新的瘘道形成。结论：下颌骨放射性骨坏死伴面部软组织坏死应积极手术治疗，下颌骨的切除手术应在正常边缘上截骨，彻底清除病变坏死组织，方可达到疾病治愈或防止复发，同时行游离腓骨瓣联合前臂皮瓣整复面部组织缺损，能理想地恢复面部的外形及口腔功能。

Combined free fibula flap and forearm flap in reconstruction of osteoradionecrosis of mandible

Objective:To probe into radical approaches of extensive osteoradionerosis of mandible,evaluate using vascularized fibula flap and forearm flap for construction.Method:The fibula flap and forearm flap were used in 5 cases to replace mandibles with radionecrosis damage.Extensive necrotive bone,persistent fistula were indications for such a radical approach.Mandible defects after resection were around 6.5 cm long,and in all cases intraoral mucosa and skin were included with bone excision.Result:All vascularized fibula flap and forearm flap transplanted were successful with good primary bone heeling.Adequate facial symmetry and improvement in oral function were observed.No evidence of osteoradionecrosis recurrence was observed after a mean following period 6 months.Conclusion:Radionecrosis of mandible can by extensive resection of sequestrum,using the vascularized fibula flap and forearm flap can obtain facial aesthetic and oral functional.