Yeung Richie W K, Samman Nabil, Cheung Lim K, Zhang Chenping, Chow Raymond L K
Department of Oral and Maxillofacial Surgery, University of Hong Kong, Prince Philip Dental Hospital, Hong Kong.
J Oral Maxillofac Surg. 2007 Jun;65(6):1128-34. doi: 10.1016/j.joms.2006.05.067.
To describe a method for stereomodel-assisted fibula flap harvest and mandibular reconstruction utilizing multiple fibula bony segments.
Stereomodels of the mandible and the fibula were obtained from computed tomography scan data. The length of fibula to be harvested was predetermined by measurement of the stimulated of existing mandibular defect on the mandibular stereomodel. A titanium reconstruction plate was shaped to fit the original mandibular contour. The stereomodel fibula was divided into multiple segments and the segments were placed on the mandibular stereomodel in the ideal edentulous position against the upper dentition and simulate the angular contour of the mandible for best comesis. The predetermined bony segments were measured and the system was then transferred to the patient in the operation theater using acrylic locating splints.
Experience with 8 patients (2 primary and 2 secondary reconstructions) indicated that a good clinical outcome in terms of mandibular contour and positions of the reconstructed segment was possible. The outer facial appearance and symmetry were consistently excellent and no instability or malposition of the graft segments was encountered.
Stereomodel-assisted fibula flap harvest and insertion is a worthwhile attempt at improving the results of mandibular reconstruction and deserves further attention.
描述一种利用多个腓骨骨段进行立体模型辅助腓骨瓣切取及下颌骨重建的方法。
从计算机断层扫描数据获取下颌骨和腓骨的立体模型。通过测量下颌骨立体模型上现存下颌骨缺损的大小来预先确定要切取的腓骨长度。将钛重建板塑形以贴合下颌骨原始轮廓。将立体模型腓骨分成多个骨段，并将这些骨段放置在下颌骨立体模型上，使其处于理想的无牙位置，与上牙列相对，并模拟下颌骨的角状轮廓以达到最佳美观效果。测量预先确定的骨段，然后使用丙烯酸定位夹板将该系统转移至手术室中的患者身上。
对8例患者（2例一期重建和2例二期重建）的经验表明，在下颌骨轮廓和重建骨段位置方面取得良好临床效果是可行的。面部外观和对称性始终极佳，未遇到移植骨段的不稳定或错位情况。
立体模型辅助腓骨瓣切取及植入是改善下颌骨重建效果的一项有价值的尝试，值得进一步关注。
