García-Díez Eloy-Miguel, Cho-Lee Gui-Youn, Raigosa-García Javier-Mauricio, Sieira-Gil Ramón, Martí Pagès Carles
Staff Surgeon, Oral and Maxillofacial Surgery Unit, Department of Pediatric Surgery, University Hospital Sant Joan de Déu, Barcelona, Spain.
J Oral Maxillofac Surg. 2013 Dec;71(12):2156-68. doi: 10.1016/j.joms.2013.05.009. Epub 2013 Aug 12.
Microvascular surgery has become the preferred method for mandibular reconstruction. A neck incision frequently is required for malignant tumor resections to carry out the dissection. The authors suggest a rhytidectomy approach for mandibular reconstruction with microvascular free flaps after the resection of benign tumors.
Seven patients with lateral mandibular defects resulting from resection of benign mandibular tumors were treated in the author's department. A combined rhytidectomy approach with an intraoral incision was used for mandibular resection and reconstruction of the defects using vascularized free osseous flaps.
The study was comprised of 3 men and 4 women with a mean age of 37.57 years (range, 28 to 50 years). Follow-up ranged from 9 to 87 months after surgery (mean, 56.28 months). The iliac crest was used for reconstruction in 6 patients, whereas the fibula was used in 1 patient. Transient paresis of the marginal nerve was observed in 2 patients. Flap loss occurred in 1 patient and required repeat microvascular reconstructive surgery. Dental rehabilitation with osseointegrated implants was performed in 4 patients. At the end of the follow-up period, successful mandibular reconstruction was achieved in all patients. Functional outcome was regarded as excellent in all patients, whereas esthetic outcome was judged excellent in 6 patients and good in 1 patient.
A rhytidectomy approach combined with an intraoral incision for microvascular mandibular reconstruction after the resection of benign tumors is a feasible technique that provides good exposure of the anatomic structures, an inconspicuous facial scar, and adequate facial contour and symmetry. Excellent clinical results are reported with the use of this technique, which should be included in the surgical armamentarium for mandibular reconstruction.
微血管外科手术已成为下颌骨重建的首选方法。对于恶性肿瘤切除，通常需要颈部切口来进行解剖。作者建议在良性肿瘤切除后，采用除皱术式联合微血管游离皮瓣进行下颌骨重建。
作者所在科室治疗了7例因良性下颌骨肿瘤切除导致下颌骨外侧缺损的患者。采用除皱术式联合口内切口进行下颌骨切除，并使用带血管蒂的游离骨瓣修复缺损。
该研究包括3名男性和4名女性，平均年龄37.57岁（范围28至50岁）。术后随访时间为9至87个月（平均56.28个月）。6例患者采用髂嵴进行重建，1例患者采用腓骨。2例患者出现边缘神经短暂性麻痹。1例患者发生皮瓣坏死，需要再次进行微血管重建手术。4例患者采用骨整合种植体进行牙齿修复。随访期末，所有患者均成功实现下颌骨重建。所有患者的功能结局均被认为优秀，而美学结局6例患者评为优秀，1例患者评为良好。
良性肿瘤切除后，采用除皱术式联合口内切口进行微血管下颌骨重建是一种可行的技术，可良好暴露解剖结构，面部瘢痕不明显，面部轮廓和对称性良好。使用该技术报告了出色的临床结果，应将其纳入下颌骨重建的手术方法中。
