Iyer Subramania, Thankappan Krishnakumar
Department of Plastic, Reconstructive and Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
Indian J Plast Surg. 2014 Jan;47(1):8-19. doi: 10.4103/0970-0358.129618.
Maxillary reconstruction is still an evolving art when compared to the reconstruction of the mandible. The defects of maxilla apart from affecting the functions of the speech, swallowing and mastication also cause cosmetic disfigurement. Rehabilitation of the form and function in patients with maxillary defects is either by using an obturator prosthesis or by a surgical reconstruction. Literature is abundant with a variety of reconstructive methods. The classification systems are also varied, with no universal acceptance of any one of them. The oncologic safety of these procedures is still debated, and conclusive evidence in this regard has not emerged yet. Management of the orbit is also not yet addressed properly. Tissue engineering, that has been hyped to be one of the possible solutions for this vexing reconstructive problem, has not come out with reliable and reproducible results so far. This review article discusses the rationale and oncological safety of the reconstructing the maxillary defects, critically analyzes the classification systems, offers the different reconstructive methods and touches upon the controversies in this subject. The management of the retained and exenterated orbit associated with maxillectomy is reviewed. The surgical morbidity, complications and the recent advances in this field are also looked into. An algorithm, based on our experience, is presented.
与下颌骨重建相比，上颌骨重建仍是一门不断发展的技术。上颌骨缺损除了影响言语、吞咽和咀嚼功能外，还会导致面容毁损。上颌骨缺损患者的形态和功能恢复可通过使用阻塞器假体或手术重建来实现。关于各种重建方法的文献丰富。分类系统也各不相同，没有一种得到普遍认可。这些手术的肿瘤学安全性仍存在争议，目前尚未出现这方面的确凿证据。眼眶的处理也尚未得到妥善解决。组织工程曾被大肆宣扬为解决这一棘手重建问题的可能方法之一，但迄今为止尚未取得可靠且可重复的结果。这篇综述文章讨论了上颌骨缺损重建的原理和肿瘤学安全性，批判性地分析了分类系统，介绍了不同的重建方法，并探讨了该领域的争议。本文还对上颌骨切除术后保留和摘除眼眶的处理进行了综述。同时也研究了手术发病率、并发症以及该领域的最新进展。基于我们的经验，给出了一种算法。
