数字化外科辅助下以咬合为导向的髂骨瓣重建上颌骨缺损的8例临床病例分析

中国口腔医学继续教育杂志 ›› 2022, Vol. 25 ›› Issue (6): 369-374.

数字化外科辅助下以咬合为导向的髂骨瓣重建上颌骨缺损的8例临床病例分析

刘付剑锋, 康一帆, 吕晓鸣, 丁梦坤, 单小峰, 蔡志刚^*

北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心

出版日期:2022-11-30 发布日期:2022-11-28
通讯作者: ^*蔡志刚,联系方式 010-82195956,电子邮箱 c2013xs@163.com,通讯地址北京市海淀区中关村南大街22号,100081
基金资助:
首都卫生发展科研专项项目（CFH2020-2-4102）

Online:2022-11-30 Published:2022-11-28

摘要/Abstract

摘要： 目的: 探讨数字化外科辅助下以咬合为导向的髂骨瓣重建上颌骨缺损的效果。方法: 对2020年12月至2021年12月在北京大学口腔医院行数字化外科辅助上颌骨肿物切除、即刻上颌骨重建手术的8例患者的临床资料进行回顾分析。主要评价指标为牙弓重建率、重建牙弓与镜像牙弓之间的夹角、最大及最小颌间距离,次要评价指标为手术时间及面部对称性满意度。结果: 8例患者中,男性4例,女性4例。中位数年龄为32岁（范围：15岁~55岁）。平均牙弓重建率为（86.3±5.7）%,重建牙弓与镜像牙弓的平均夹角为（11.4±6.7）°,平均最大颌间距离为（12.9±1.5）mm,平均最小颌间距离为（8.6±2.3）mm, 平均手术时间为（326±60）min。所有患者对术后外形的恢复均满意。结论: 数字化外科辅助下以咬合为导向的髂骨瓣重建上颌骨缺损能够获得较好的远期种植义齿修复条件。

关键词: 数字化外科, 咬合导向, 髂骨瓣, 上颌骨缺损, 颌骨重建

刘付剑锋, 康一帆, 吕晓鸣, 丁梦坤, 单小峰, 蔡志刚. 数字化外科辅助下以咬合为导向的髂骨瓣重建上颌骨缺损的8例临床病例分析[J]. 中国口腔医学继续教育杂志, 2022, 25(6): 369-374.

参考文献

[1] Genden EM, Okay D, Stepp MT, et al.Comparison of functional and quality-of-life outcomes in patients with and without palatomaxillary reconstruction:a preliminary report[J]. Arch Otolaryngol Head Neck Surg. 2003; 129(7):775-780.
[2] Lee ZH, Cripps C, Rodriguez ED.Current Concepts in Maxillary Reconstruction[J]. Plast Reconstr Surg. 2022; 150(1):168e-175e.
[3] Brown JS, Shaw RJ.Reconstruction of the maxilla and midface:introducing a new classification[J]. Lancet Oncol. 2010; 11(10):1001-1008.
[4] Padilla PL, Mericli AF, Largo RD, et al.Computer-Aided Design and Manufacturing versus Conventional Surgical Planning for Head and Neck Reconstruction:A Systematic Review and Meta-Analysis[J]. Plast Reconstr Surg. 2021; 148(1):183-192.
[5] Rodby KA, Turin S, Jacobs RJ, et al.Advances in oncologic head and neck reconstruction:systematic review and future considerations of virtual surgical planning and computer aided design/computer aided modeling[J]. J Plast Reconstr Aesthet Surg. 2014; 67(9):1171-1185.
[6] Urken ML, Vickery C, Weinberg H, et al.The internal oblique-iliac crest osseomyocutaneous free flap in oromandibular reconstruction. Report of 20 cases[J]. Arch Otolaryngol Head Neck Surg. 1989; 115(3):339-349.
[7] Kang YF, Liang J, He Z, et al.Cortical bone resorption of fibular bone after maxillary reconstruction with a vascularized fibula free flap:a computed tomography imaging study[J]. Int J Oral Maxillofac Surg. 2019; 48(8):1009-1014.
[8] Chuka R, Abdullah W, Rieger J, et al.Implant Utilization and Time to Prosthetic Rehabilitation in Conventional and Advanced Fibular Free Flap Reconstruction of the Maxilla and Mandible[J]. Int J Prosthodont. 2017; 30(3):289-294.
[9] Vedran U, Kavit A, Igor B, et al.Evolution of midface microvascular reconstruction:three decades of experience from a single institution[J]. Eur Arch Otorhinolaryngol. 2022; 279(8):4173-4180.
[10] Jacek B, Maciej P, Tomasz P, et al.3D printed models in mandibular reconstruction with bony free flaps[J]. J Mater Sci Mater Med. 2018; 29(3):23.
[11] May MM, Howe BM, O’Byrne TJ, et al. Short and long-term outcomes of three-dimensional printed surgical guides and virtual surgical planning versus conventional methods for fibula free flap reconstruction of the mandible:Decreased nonunion and complication rates[J]. Head Neck. 2021; 43(8):2342-2352.
[12] Rohner D, Jaquiéry C, Kunz C, et al.Maxillofacial reconstruction with prefabricated osseous free flaps:a 3-year experience with 24 patients[J]. Plast Reconstr Surg. 2003; 112(3):748-757.
[13] Patel SY, Kim DD, Ghali GE.Maxillofacial Reconstruc-tion Using Vascularized Fibula Free Flaps and Endosseous Implants[J]. Oral Maxillofac Surg Clin North Am. 2019; 31(2):259-284.
[14] 杨宗燕, 康一帆, 吕晓鸣, 等. 血管化髂骨瓣重建下颌骨有牙区缺损时髂骨嵴不同朝向的优缺点比较[J]. 中国口腔颌面外科杂志, 2021, 19(5):434-438.
[15] Zhang WB, Soh HY, Yu Y, et al.Improved procedure for Brown’s Class III maxillary reconstruction with composite deep circumflex iliac artery flap using computer-assisted technique[J]. Comput Assist Surg (Abingdon). 2021; 26(1):9-14.
[16] Jang WH, Lee JM, Jang S, et al.Mirror Image Based Three-Dimensional Virtual Surgical Planning and Three-Dimensional Printing Guide System for the Reconstruction of Wide Maxilla Defect Using the Deep Circumflex Iliac Artery Free Flap[J]. J Craniofac Surg. 2019; 30(6):1829-1832.
[17] Grinsell D, Catto-Smith HE.Modifications of the deep circumflex iliac artery free flap for reconstruction of the maxilla[J]. J Plast Reconstr Aesthet Surg. 2015; 68(8):1044-1053.
[18] Kroll SS, Schusterman MA, Reece GP, et al.Choice of flap and incidence of free flap success[J]. Plast Reconstr Surg. 1996; 98(3):459-463.
[19] Zheng L, Wu W, Shi Y, et al.Mandibular Reconstruction With a Deep Circumflex Iliac Artery Flap Using Computer-Assisted and Intraoral Anastomosis Techniques[J]. J Oral Maxillofac Surg. 2019; 77(12):2567-2572.
[20] Bueno de Vicente A, Almeida F, Nuñez JA, et al. Intraoral anastomosis in maxillary microvascular reconstruction after oncological excision[J]. Int J Oral Maxillofac Surg. 2021; 50(9):1161-1167.