Chang Yang-Ming, Chana Jagdeep S, Wei Fu-Chan, Tsai Chi-Ying, Chen Samuel H T
Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
Plast Reconstr Surg. 2003 Jul;112(1):31-6. doi: 10.1097/01.PRS.0000065910.66161.DD.
Malocclusion may result after free fibula flap reconstruction of the mandible, because of inadequate positioning of the temporomandibular joint, inaccurate contouring of the reconstruction plate, or subsequent fracture of a miniplate. Factors that alter the vascularity of the transplanted fibula may also result in a delayed presentation of malocclusion. Seven cases are presented, in which primary surgical treatment consisted of segmental mandibulectomy and reconstruction with a free fibula osteoseptocutaneous flap. Fixation was achieved with a reconstruction plate in five cases and a miniplate in two cases. Malocclusion was corrected with an osteotomy performed at the junction of the fibula and the native mandible. The new osteotomy sites were fixed with miniplates and maintained with intermaxillary fixation. Complete bony union was achieved at the osteotomy sites. The correction of malocclusion was successful in all cases, and all patients have resumed a normal diet. This report demonstrates that osteotomy and realignment of the mandible are effective for the secondary correction of malocclusion after mandibular reconstruction with the free fibula osteoseptocutaneous flap.
由于颞下颌关节定位不当、重建钢板塑形不准确或微型钢板随后发生骨折，下颌骨游离腓骨瓣重建后可能会出现错牙合畸形。改变移植腓骨血运的因素也可能导致错牙合畸形延迟出现。本文报告7例病例，其一期手术治疗包括节段性下颌骨切除术并用游离腓骨骨皮瓣进行重建。5例用重建钢板固定，2例用微型钢板固定。在腓骨与原下颌骨交界处进行截骨术矫正错牙合畸形。新的截骨部位用微型钢板固定，并用颌间固定维持。截骨部位实现了完全骨愈合。所有病例错牙合畸形矫正均成功，所有患者均已恢复正常饮食。本报告表明，截骨术和下颌骨重新排列对于游离腓骨骨皮瓣下颌骨重建后错牙合畸形的二期矫正有效。
