Lin Pao-Yuan, Lin Kevin C, Jeng Seng-Feng
Section of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan.
ISRN Surg. 2011;2011:824251. doi: 10.5402/2011/824251. Epub 2011 Dec 12.
Oromandibular reconstruction resulting from resection of benign tumor, malignant cancer, osteomyelitic or osteoradionecrotic mandible remains a challenge for plastic surgeons today. At present, fibula osteocutaneous flap is the perhaps most commonly used technique for oromandibular reconstruction because of its potential for contouring, immediate dental implant placement, and favorable donor site morbidity. In this study, we review the history of oromandibular reconstruction, summarize the characteristics of different osteocutaneous flaps, offer surgical options of different osteocutaneous flaps, and provide reconstructive strategies for different locations of mandibular defects. Furthermore, we give a detailed description of various modifications in oromandibular reconstruction: (1) the myoosseous flap for lateral segmental defect repair may reduce donor site complication; (2) to improve the function of oral commissure in patients with obscure recipient vessels, we modify the fibula osteocutaneous flap with anterolateral thigh flap and combine the tensor fascia lata using one set of recipient vessel for composite oromandibular reconstruction; (3) to decrease the likelihood of neck infection and improve aesthetic result, we add the segmental soleus muscle to the fibula osteocutaneous flap to obliterate and augment submandibular dead space. Lastly, dental rehabilitation considerations associated with mandibular reconstruction have been given to help assist in surgical treatment planning.
因良性肿瘤、恶性癌症、骨髓炎或放射性骨坏死性下颌骨切除而进行的口腔颌面部重建，至今仍是整形外科医生面临的一项挑战。目前，腓骨骨皮瓣可能是口腔颌面部重建中最常用的技术，因为它具有塑形潜力、可即刻植入牙种植体，且供区并发症较少。在本研究中，我们回顾了口腔颌面部重建的历史，总结了不同骨皮瓣的特点，提供了不同骨皮瓣的手术选择，并针对下颌骨缺损的不同部位提供了重建策略。此外，我们详细描述了口腔颌面部重建中的各种改良方法：（1）用于修复外侧节段性缺损的肌骨瓣可减少供区并发症；（2）为改善受区血管不明确患者的口角功能，我们用股前外侧皮瓣改良腓骨骨皮瓣，并使用一组受区血管将阔筋膜张肌联合起来进行复合口腔颌面部重建；（3）为降低颈部感染的可能性并改善美学效果，我们在腓骨骨皮瓣上添加节段性比目鱼肌以消除和增加下颌下死腔。最后，还考虑了与下颌骨重建相关的牙齿修复问题，以帮助辅助手术治疗规划。
