Zhang Lei, Sun Hao, Yu Hong-bo, Yuan Hao, Shen Guo-fang, Wang Xu-dong
Department of Oral and Cranio-maxillofacial Science, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
J Craniofac Surg. 2013 May;24(3):886-9. doi: 10.1097/SCS.0b013e31827ff370.
Maxillectomy in childhood not only causes composite primary defects but also secondary malformation of the middle and lower face. In the case presented, we introduced computer-assisted planning and simulation of orthognathic surgery combined with fibular osteomyocutaneous flap reconstruction to correct complex craniofacial deformities. Virtual orthognathic surgery and maxillary reconstruction surgery were undertaken preoperatively. LeFort I osteotomy, with bilateral sagittal split ramus osteotomy and lower border ostectomy, was performed to correct malocclusion and facial asymmetry. Maxillary reconstruction was accomplished using a fibular osteomyocutaneous flap. The patient recovered uneventfully with an adequate aesthetic appearance on 3D computed tomography. Our experience indicates that orthognathic surgery combined with fibular osteomyocutaneous flap reconstruction can used to correct complex facial asymmetry and maxillary defects secondary to maxillectomy. Computer-assisted simulation enables precise execution of the reconstruction. It shortens the free flap ischemia time and reduces the risks associated with microsurgery.
儿童上颌骨切除术不仅会导致复合性原发性缺损，还会引起中面部和下面部的继发性畸形。在本病例中，我们引入了计算机辅助的正颌外科手术规划和模拟，并结合腓骨肌皮瓣重建术来矫正复杂的颅面畸形。术前进行了虚拟正颌手术和上颌骨重建手术。实施了LeFort I截骨术，并联合双侧矢状劈开下颌支截骨术和下颌下缘截骨术，以矫正咬合不正和面部不对称。采用腓骨肌皮瓣完成上颌骨重建。患者术后恢复顺利，三维计算机断层扫描显示面部外观良好。我们的经验表明，正颌外科手术联合腓骨肌皮瓣重建术可用于矫正上颌骨切除术后继发的复杂面部不对称和上颌骨缺损。计算机辅助模拟能够精确地进行重建手术。它缩短了游离皮瓣的缺血时间，并降低了显微外科手术相关的风险。
