Muzaffar A R, Adams W P, Hartog J M, Rohrich R J, Byrd H S
Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas 75235, USA.
Plast Reconstr Surg. 1999 Dec;104(7):2172-83; quiz 2184. doi: 10.1097/00006534-199912000-00035.
Maxillary reconstruction is a challenging endeavor in functional and aesthetic restoration. Given its central location in the midface and its contributions to the key midfacial elements--the orbits, the zygomaticomaxillary complex, the nasal unit, and the stomatognathic complex--the maxilla functions as the keystone of the midface and unifies these elements into a functional and aesthetic unit. Maxillary defects are inherently complex because they generally involve more than one midfacial component. In addition, most maxillary defects are composite in nature, and they often require skin coverage, bony support, and mucosal lining for reconstruction. In the reconstruction of maxillary defects secondary to trauma, ablative tumor surgery, or congenital deformities, the following goals must be met: (1) obliteration of the defect; (2) restoration of essential functions of the midface, such as mastication and speech; (3) provision for adequate structural support to each of the midfacial units; and (4) aesthetic reconstruction of the external features. This review will discuss the pertinent anatomic considerations, the historical approaches to maxillary reconstruction, and the merits of the techniques in use today, with an emphasis on state-of-the-art reconstruction and dental rehabilitation of extensive maxillary defects.
上颌骨重建是功能和美学修复方面一项具有挑战性的工作。鉴于上颌骨位于面中部的中心位置，并对关键的面中部结构——眼眶、颧上颌复合体、鼻单元和口颌复合体——有重要作用，上颌骨是面中部的关键结构，将这些结构整合为一个功能和美学单元。上颌骨缺损本质上较为复杂，因为它们通常涉及不止一个面中部结构。此外，大多数上颌骨缺损本质上是复合性的，重建时往往需要皮肤覆盖、骨支撑和黏膜内衬。在因创伤、肿瘤切除手术或先天性畸形导致的上颌骨缺损重建中，必须实现以下目标：（1）消除缺损；（2）恢复面中部的基本功能，如咀嚼和言语功能；（3）为每个面中部结构提供足够的结构支撑；（4）对外貌进行美学重建。本综述将讨论相关的解剖学要点、上颌骨重建的历史方法以及当今所用技术的优点，重点是广泛上颌骨缺损的先进重建和牙齿修复。
