Wang Chih-Chun, Cheng Ming-Huei, Hao Sheng-Po, Wu Chia-Chen, Huang Shan-Shung
Department of Otolaryngology-Head and Neck Surgery, Chang Gung Cancer Center Chang Gung Memorial Hospital and Chang Gung University, Taiwan.
Laryngoscope. 2005 Nov;115(11):1963-7. doi: 10.1097/01.mlg.0000178374.29219.5e.
To evaluate the outcome of simultaneous anterior mandibulotomy and marginal mandibulectomy for patients with oral cavity cancer.
The medical charts of seven patients who underwent simultaneous anterior mandibulotomy and marginal mandibulectomy for oral cavity cancer between July 1994 and June 2004 in Chang Gung Memorial Hospital, Taiwan were retrospectively reviewed. These seven patients had no prior radiation therapy nor clinical or radiographic evidence of mandible bone invasion.
Seven patients, between 34 to 62 years of age, were followed up in the clinics from 4.5 to 39 months with an average of 19.4 months. Five (71%) patients developed mandible osteoradionecrosis. Among them, two patients underwent radical sequestrectomy followed by reconstruction with a free fibular osteoseptocutaneous flap or soft tissue flap, and the other three patients either received removal of the mandible fixation miniplate, limited sequestrectomy of the mandible, or conservative antibiotic treatment individually.
Simultaneous anterior mandibulotomy and marginal mandibulectomy results in a high morbidity rate of avascular necrosis of the mandible and therefore should be avoided. To avoid a disastrous complication, segmental mandibulectomy and a composite free fibular osteoseptocutaneous flap reconstruction would be a preferred surgical alternative.
评估口腔癌患者同期行下颌骨前部切开术和下颌骨边缘切除术的疗效。
回顾性分析1994年7月至2004年6月期间在台湾长庚纪念医院接受同期下颌骨前部切开术和下颌骨边缘切除术治疗口腔癌的7例患者的病历。这7例患者既往均未接受过放疗，且无下颌骨骨侵犯的临床或影像学证据。
7例患者年龄在34至62岁之间，门诊随访4.5至39个月，平均19.4个月。5例（71%）患者发生下颌骨放射性骨坏死。其中，2例患者接受了根治性死骨切除术，随后采用游离腓骨骨皮瓣或软组织瓣进行重建，另外3例患者分别接受了下颌骨固定微型钢板取出术、下颌骨局限性死骨切除术或保守抗生素治疗。
同期下颌骨前部切开术和下颌骨边缘切除术导致下颌骨无血管性坏死的发病率较高，因此应避免采用。为避免灾难性并发症，节段性下颌骨切除术和游离腓骨骨皮瓣复合重建术将是首选的手术方式。
