摘要
目的探讨采用口内入路切除下颌骨良性肿瘤同期自体骨移植修复重建术的临床疗效。方法2009年1月-2012年9月，收治15例下颌骨良性肿瘤患者。其中男7例，女8例；年龄18～45岁，平均30岁。病理诊断为成釉细胞瘤11例，牙源性角化囊肿3例，黏液瘤1例。病变缺损部位按Urken’SCRBS分类：下颌骨同侧体部（B型）3例，升支（R型）3例，体部＋升支（BR型）9例。手术均采用口内入路（1例因病变部位至乙状切迹平面，在耳前行辅助切口）。分别采用以计算机辅助设计／计算机辅助制造技术构建的下颌骨模型上弯制重建钛板（9例）或术中直接按颌骨形状弯制重建钛板（6例）。切除下颌骨肿瘤后将弯制重建钛板原位固定，根据骨缺损情况分别采用自体髂骨（11例）或血管化腓骨瓣（4例）移植修复。6例保留下齿槽神经。结果术后14例切口I期愈合；1例发生植骨区感染，经相应处理后II期愈合。15例均获随访，随访时间1～4年，平均2．5年。末次随访时，患者功能均恢复良好，无面神经损伤表现，余留牙列咬合关系基本维持术前状态；咀嚼功能满意；开口度30～35mm，平均33mm；吞咽及语言功能正常。口外仅有辅助切口及穿颊器轻微瘢痕，患者对面部外形满意。6例保留下齿槽神经患者术后下唇麻木症状缓解。随访期间均无复发。结论经口内入路切除下颌骨良性肿瘤同期行自体骨植骨修复重建术后面部无明显瘢痕，几乎不损伤面神经，外形恢复良好，是可靠的美容性手术入路和手术重建方案。
Objective To investigate the clinical outcomes of resection of mandibular benign tumors and primary reconstruction with autogenous bone graft via an intraoral approach. Methods Fifteen patients with mandibular benign tumors were treated between January 2009 and September 2012. There were 7 males and 8 females, aged from 18 to 45 years （mean, 30 years）. The pathological diagnosis identified 11 cases of ameloblastoma, 3 cases of odontogenic keratocyst, and 1 case of odontogenic myxoma. According to the Urken＇s CRBS （Condyle, Ramus, Body, Symphysis） classification criteria based on the location of the mandibular defect, there were 3 cases of body type （B type）, 3 cases of ramus type （R type）, and 9 cases of body and ramus type （BR type）. The surgeries were performed via an intraoral approach, except 1 patient with the lesion at the level of sigmoid notch via an auxiliary preauricular incision. To fix the bone grafts to the dissected mandibular defects, reconstructive titanium plates were used, either indirectly according to the computer aided design/computer aided manufacturing mandibular models before surgery （9 patients） or directly according to the exposed mandibles during surgery （6 patients）. The patients received benign mandibular tumor resection and primary autogenous bone graft reconstruction with free iliac bones （11 cases） or vascularized fibular flaps （4 cases）. The mandibular inferior alveolar nerves were preserved in 6 cases. Results Primary healing of incision was obtained in 14 patients, while secondary healing in 1 patient suffering from bone graft infection. All the patients were followed up 1-4 years （mean, 2.5 years）. At last follow-up, no patients showed facial nerve damage; occlusion of remaining teeth was similar to preoperative conditions; the chewing function was satisfactory; mouth opening was 30- 35 mm （mean, 33 mm）; and swallowing and speaking functions were normal. Only slight extraoral scars caused by the auxiliary incision and the transbuccal appliances were observed, and all the patients were satisfied with the tactai appearance. numbness was relived in patients with preserved inferior alveolar nerves. There was no tumor recurrence during follow-up period. Conclusion The intraoral approach is a feasible and proper approach for resection of benign mandibular tumors and primary reconstruction with autogenous bone grafts, with the advantages of inconspicuous facial scars, minimum damage to the facial nerve, and expectable aesthetic appearance.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第2期192-196,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
浙江省卫生厅基金资助项目(N20110323)~~
关键词
口内入路
良性肿瘤
下颌骨缺损
血管化腓骨瓣移植
修复重建
Intraoral approach
Benign tumor
Mandibular defect
Vascularized fibular flaptransplantation
Repair and reconstruction
