颌骨广泛性成釉细胞瘤:手术治疗及应用微血管皮瓣即刻重建

Extensive ameloblastoma of the jaws: surgical management and immediate reconstruction using microvascular flaps.

作者信息

Zemann Wolfgang, Feichtinger Matthias, Kowatsch Eberhard, Kärcher Hans

机构信息

Department of Oral and Maxillofacial Surgery, Medical University of Graz, Graz, Austria.

出版信息

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Feb;103(2):190-6. doi: 10.1016/j.tripleo.2006.05.004. Epub 2006 Sep 25.

Abstract

OBJECTIVE

Ameloblastoma is a rare histological benign but locally aggressive tumor with a marked tendency for recurrence. Especially larger, aggressive lesions require a more radical surgical approach resulting in large jaw defects. The purpose of this study is to analyze the long-term functional and esthetic results after immediate reconstruction of large jaw defects using microvascular flaps.

STUDY DESIGN

A review of 7 cases of giant ameloblastoma (2 in the maxillary and 5 in the mandibular region) is presented. The lesions were between 4 and 8 cm in diameter. All patients were treated by a radical surgical protocol. All cases were immediately reconstructed using microvascular grafts from either the scapula or the iliac crest bone. Dental implants were inserted in all patients after removal of the osteosynthesis material.

RESULTS

All patients were prosthetically rehabilitated. All implants survived throughout the observation time. The esthetic and functional outcomes were satisfying in all patients. No case of recurrence of the tumor could be observed so far.

CONCLUSION

According to our opinion, immediate reconstruction is the treatment of choice after radical surgical excision of ameloblastoma. This 1-step procedure decreases the number of surgeries and allows earlier prosthetic rehabilitation.

摘要

目的

成釉细胞瘤是一种罕见的组织学上为良性但具有局部侵袭性的肿瘤,有明显的复发倾向。尤其是较大的侵袭性病变需要更激进的手术方法,这会导致大面积的颌骨缺损。本研究的目的是分析使用微血管皮瓣立即重建大型颌骨缺损后的长期功能和美学效果。

研究设计

对7例巨大成釉细胞瘤病例(上颌2例,下颌5例)进行回顾性研究。病变直径在4至8厘米之间。所有患者均采用根治性手术方案治疗。所有病例均立即使用来自肩胛骨或髂嵴骨的微血管移植物进行重建。在取出骨合成材料后,所有患者均植入了牙种植体。

结果

所有患者均接受了修复治疗。在整个观察期内,所有种植体均存活。所有患者的美学和功能结果均令人满意。迄今为止,未观察到肿瘤复发的病例。

结论

我们认为,在成釉细胞瘤根治性手术切除后,立即重建是首选的治疗方法。这种一步法减少了手术次数,并允许更早地进行修复治疗。

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