Amrani Saar, Anastassov George E, Montazem Andre H
Department of Oral and Maxillofacial Surgery, Mount Sinai School of Medicine, New York, NY, USA.
J Oral Maxillofac Surg. 2010 Mar;68(3):641-6. doi: 10.1016/j.joms.2009.09.100.
To evaluate the utility of autogenous extended mandibular ramus and coronoid process bone grafts for maxillofacial reconstructive surgery.
Twelve patients aged 23 to 76 years (mean, 52) who underwent extended ramus/coronoid process grafts for reconstruction of maxillofacial deformities due to trauma, alveolar atrophy, or iatrogenic nasal deformity. All patients had either unilateral or bilateral combined coronoid process-mandibular ramus bone grafts for their reconstruction. There was 1 nasal reconstruction, 2 unilateral mandibles, 1 bilateral mandible, 4 unilateral maxillas, 1 unilateral maxilla and mandible combined, and 1 bilateral maxilla and mandible combined.
The procedure was considered a success when the patient's deformities were reconstructed ad integrum and when there were no failures of the dental implants placed in the augmented areas as of the longest follow-up. All patients were successfully reconstructed. There was 1 infection at a donor site that resolved with local care and oral antibiotics. All but 1 of the maxillary and mandibular alveolar augmentations underwent endosteal implant placement approximately 4 to 6 months following grafting. The nasal reconstruction restored normal function and symmetry.
Using both the coronoid process of the mandible and the mandibular ramus as a source for autogenous bone graft can provide sufficient bone in quantity and quality for selected maxillofacial reconstructions.
评估自体下颌升支延长及冠突骨移植在颌面重建手术中的应用价值。
12例年龄在23至76岁（平均52岁）的患者，因创伤、牙槽萎缩或医源性鼻畸形接受下颌升支/冠突延长移植以重建颌面畸形。所有患者均采用单侧或双侧联合冠突 - 下颌升支骨移植进行重建。其中鼻重建1例，单侧下颌骨重建2例，双侧下颌骨重建1例，单侧上颌骨重建4例，单侧上颌骨与下颌骨联合重建1例，双侧上颌骨与下颌骨联合重建1例。
当患者畸形得到完全重建且在最长随访期时，植骨区植入的牙种植体无失败情况时，该手术被认为成功。所有患者均成功重建。供区有1例感染，经局部处理及口服抗生素后痊愈。除1例上颌和下颌牙槽嵴增高术外，其余患者在植骨后约4至6个月均接受了骨内种植体植入。鼻重建恢复了正常功能和对称性。
将下颌冠突和下颌升支作为自体骨移植的来源，可为特定的颌面重建提供数量和质量均充足的骨组织。
