Hashikawa Kazunobu, Tahara Shinya, Ishida Haruhiko, Yokoo Satoshi, Sanno Toshiaki, Terashi Hiroto, Nibu Ken-ichi
Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Plast Reconstr Surg. 2006 Mar;117(3):963-7. doi: 10.1097/01.prs.0000200623.91956.66.
Reconstruction of eye globe-sparing total maxillectomy defects is one of the major challenges to reconstructive surgeons. In 1994, the authors developed an uncomplicated and easy reconstructive method, where a titanium mesh is applied for the support of orbital contents, a radial forearm free flap for covering the mesh and the cheek lining, and an obturator prosthesis for palatal and dental rehabilitation.
Five patients who underwent primary reconstruction with the authors' method after globe-sparing maxillectomy with loss of the orbital floor from 1994 to 1999 and who were followed up for more than 5 years were retrospectively reviewed for (1) the presence of diplopia, (2) the shape of the reconstructed orbital floor assessed by coronal section magnetic resonance imaging, and (3) the presence of infection/exposure of the titanium mesh.
Only one of the five patients developed slight diplopia. Coronal magnetic resonance imaging showed that the orbital floor restored with titanium mesh had in all cases maintained a proper shape and position for more than 5 years. No infection or exposure of the titanium mesh had developed in any of the cases, despite exposure to irradiation of not less than 30 Gy. All the patients had well-retentive obturator prostheses.
This long-term follow-up study demonstrated that the authors' method attained a long-lasting successful outcome functionally and is the method of choice for reconstruction after globe-sparing total maxillectomy.
保留眼球的全上颌骨切除术后缺损的重建是重建外科医生面临的主要挑战之一。1994年，作者开发了一种简单易行的重建方法，即应用钛网支撑眶内容物，采用桡侧前臂游离皮瓣覆盖钛网和颊黏膜，并用赝复体进行腭部和牙列修复。
回顾性分析1994年至1999年间5例因保留眼球的上颌骨切除导致眶底缺失而采用作者方法进行一期重建且随访时间超过5年的患者，评估（1）复视情况；（2）通过冠状面磁共振成像评估重建眶底的形态；（3）钛网有无感染/外露。
5例患者中仅1例出现轻度复视。冠状面磁共振成像显示，所有采用钛网重建的眶底在5年多的时间里均保持了合适的形态和位置。尽管接受了不少于30 Gy的放疗，但所有病例均未发生钛网感染或外露。所有患者的赝复体固位良好。
这项长期随访研究表明，作者的方法在功能上取得了长期成功的结果，是保留眼球的全上颌骨切除术后重建的首选方法。
