King Timothy W, Gallas Mennen T, Robb Geoffery L, Lalani Zahid, Miller Michael J
Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
J Reconstr Microsurg. 2002 Jul;18(5):365-71. doi: 10.1055/s-2002-33017.
The authors compared functional and aesthetic outcomes following reconstruction of the posterior mandible (i.e., unilateral defects distal to the mental foramen) with free flaps containing vascularized bone (VBFs) or only soft-tissue (STFs). Fifty-eight reconstructions of the posterior mandible were performed with STFs (n=32) or VBFs (n=26) and were available for review. All patients (n=58) completed a functional outcome questionnaire containing questions about diet, oral competence, pain, trismus, speech, cosmesis, social reintegration, and return to work. Computer-assisted image analysis was performed comparing facial proportions of patients with STFs (n=10), VBFs (n=11), or unoperated controls (n=10). VBFs yielded statistically significantly superior functional scores compared to STFs in 5/12 categories. Normal scores were found for diet in 31 percent (10/32) vs. 21 percent (3/26) ( p=0.006); oral competence in 56 percent (18/32) vs. 35 percent (9/26) ( p=0.05); and speech in 47 percent (15/32) vs. 30 percent (7/26) ( p=0.026). VBF patients returned to public dining (72 percent, 23/32) more frequently than STF patients (35 percent, 9/26), ( p=0.003). VBFs yielded superior results for midline symmetry with a mean mandible deviation of 3.3+/-2.3 mm vs. 5.8+/-3.6 mm (STFs), and 1.2+/-0.7 mm (controls, p=0.001). An objective method for the evaluation of aesthetic and functional outcomes in posterior mandible reconstruction was developed. This method demonstrated that posterior mandible reconstruction with VBFs is associated with superior results in speech, diet, and midline symmetry. However, rigorous analyses of oropharyngeal soft-tissue defects and the radiation therapy protocols utilized, were not performed in this study. Without these additional analyses, one cannot definitively conclude that VBFs are superior to STFs.
作者比较了采用含血管化骨的游离皮瓣（VBFs）或仅采用软组织游离皮瓣（STFs）重建下颌骨后部（即颏孔远端的单侧缺损）后的功能和美学效果。采用STF（n = 32）或VBF（n = 26）对58例下颌骨后部进行了重建，可供评估。所有患者（n = 58）均完成了一份功能结局问卷，其中包含有关饮食、口腔功能、疼痛、张口受限、言语、美容、社会重新融入和恢复工作等问题。对10例采用STF、11例采用VBF或10例未手术对照患者的面部比例进行了计算机辅助图像分析。在12项分类中的5项中，VBF的功能评分在统计学上显著优于STF。饮食正常评分在采用STF的患者中为31%（10/32），采用VBF的患者中为21%（3/26）（p = 0.006）；口腔功能正常评分在采用STF的患者中为56%（18/32），采用VBF的患者中为35%（9/26）（p = 0.05）；言语正常评分在采用STF的患者中为47%（15/32），采用VBF的患者中为30%（7/26）（p = 0.026）。采用VBF的患者恢复到公共就餐的比例（72%，23/32）高于采用STF的患者（35%，9/26）（p = 0.003）。VBF在中线对称性方面产生了更好的结果，下颌骨平均偏差为3.3±2.3mm，而STF为5.8±3.6mm，对照为1.2±0.7mm（p = 0.001）。开发了一种评估下颌骨后部重建美学和功能结局的客观方法。该方法表明，采用VBF重建下颌骨后部在言语、饮食和中线对称性方面产生了更好的结果。然而，本研究未对口咽软组织缺损和所采用的放射治疗方案进行严格分析。没有这些额外分析，就不能明确得出VBF优于STF的结论。
