摘要
目的探讨咬合导板及颌间牵引钉技术在游离腓骨瓣修复下颌骨缺损中的应用价值。方法 2011年8月-12月,收治7例下颌骨肿瘤患者。男4例,女3例;年龄32～65岁,中位年龄50岁。下颌骨成釉细胞瘤5例,牙龈癌2例。术前制备咬合导板并确定颌间牵引钉植入位置;术中5例行下颌骨半侧切除、2例行保留髁突的下颌骨半侧切除后,切取长11～13 cm的腓骨瓣修复下颌骨缺损,腓骨瓣固定时采用咬合导板和颌间牵引钉技术恢复咬合关系。供区直接拉拢缝合。结果手术时间7～12 h,平均9.5 h。术后腓骨瓣均成活,供、受区切口均Ⅰ期愈合。患者均获随访,随访时间10～14个月,平均12.3个月。患者面部对称,咬合关系良好,张口度及下颌侧向运动正常,双侧颞下颌关节区无疼痛等不适。全口曲面体层片显示下颌骨缺损区域重建形态及固位良好。随访期间肿瘤无复发。结论游离腓骨瓣移植修复下颌骨缺损术中应用咬合导板和颌间牵引钉技术,能简化手术操作,精确恢复患者面部外形和咬合关系,提高术后口腔舒适性。
Objective To investigate the clinical value of occlusal guide plate combined with intermaxillary fixation screw in mandibular defect repair with free fibular flap. Methods Between August and December 2011, 7 patients with mandibular tumor were treated, including 5 cases of ameloblastoma and 2 cases of gingival cancer. Of 7 patients, 4 were males and 3 were females, aged 32-65 years （median, 50 years）. Occlusal guide plate was prepared and the implanted position of intermaxillary fixation screws was determined preoperatively. Hemimandibulectomy was performed in 5 cases, half mandibular segmental resection with condyle reservation in the other 2 cases. The free fibular flaps of 11-13 cm in length were harvested for repairing mandibular defects. When the free fibular flaps were fixed, the occlusal guide plate and intermaxillary fixation screws were utilized to restorate the occlusal relation. The donor site was sutured directly. Results The average operation time was 9.5 hours （range, 7-12 hours）. All free fibular flaps survived completely. All incisions at the donor site and recipient site healed by first intention. All patients were followed up 10-14 months with an average of 12.3 months. All patients had symmetrical face, good occlusal relation, normal mouth opening, and normal mandibular lateral movement, and no pain of bilateral temporomandibular joints occurred. Panoramic tomography showed good mandibular contour and the suitable emplacement of fibular flaps postoperatively. No tumor recurrence occurred during follow-up period. Conclusion When repairing the mandibular defect with free fibular flap, occlusal guide plate with intermaxillary fixation screw contributes to simplifying operation, accurate recovery of the appearance and occlusal relation, and improving the oral comfort level postoperatively.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2013年第3期292-294,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
下颌骨缺损
咬合导板
颌间牵引钉
游离腓骨瓣
咬合关系
Mandibular defect Occlusal guide plate Intermaxillary fixation screw Free fibularflap Occlusal relation
