Fariña Rodrigo, Alister Juan Pablo, Uribe Francisca, Olate Sergio, Arriagada Alvaro
Maxillofacial Department, Hospital del Salvador, Hospital San Borja Arriarán, Dentistry School, Universidad de Chile, Santiago, Chile; Dentistry School, Universidad de La Frontera, Facultad de Medicina, Universidad de La Frontera, Maxillofacial Department of Hospital Hernán Henríquez Aravena, Temuco, Chile; and Maxillofacial Department, Hospital Base Linares, Carlos Ibáñez del Campo, Linares, Chile.
Plast Reconstr Surg Glob Open. 2016 Aug 15;4(8):e845. doi: 10.1097/GOX.0000000000000832. eCollection 2016 Aug.
Mandibular reconstruction has been the subject of much debate and research in the fields of maxillofacial surgery and head and neck surgery.
A retrospective observational study was undertaken with 14 patients diagnosed with benign tumorous pathologies and who underwent immediate mandibular resection and reconstruction at the Hospital del Salvador Maxillofacial Surgery Unit and Dr. Rodrigo Fariña's private clinic between the years 2002 and 2012. We propose a treatment algorithm, which is previous teeth extractions in area that will be removed.
Fourteen patients underwent surgery, and a total of 40 dental implants were installed in 6 men and 8 women, the mean age of 33.5 (age range, 14-58 y). Reconstruction with iliac crest bone graft, and rehabilitation following this protocol (average of reconstruction was 8.7 cm), was successful with no complications at all in 12 patients. One patient had a minor complication, and the graft was partially reabsorbed because of communication of the graft with the oral cavity. This complication did not impede rehabilitation with dental implants. Another patient suffered the total loss of the graft due to infection because of dehiscence of oral mucosa and great communication with the mouth. Another iliac crest free graft reconstruction was undertaken 6 months later.
The scientific evidence suggests that mandibular reconstruction using free grafts following the removal of benign tumors is a biologically sustainable alternative. The critical factor to improve the prognosis of free grafts reconstruction in benign tumors is to have good quality soft tissue and avoid communication with the oral cavity. For this, it is vital to do dental extractions before removing the tumor.
下颌骨重建一直是颌面外科和头颈外科领域众多争论和研究的主题。
对2002年至2012年间在萨尔瓦多医院颌面外科和罗德里戈·法里尼亚医生私人诊所诊断为良性肿瘤性病变并接受即刻下颌骨切除及重建的14例患者进行了一项回顾性观察研究。我们提出了一种治疗方案，即在将要切除的区域先行拔牙。
14例患者接受了手术，共为6名男性和8名女性植入了40颗牙种植体，平均年龄为33.5岁（年龄范围14 - 58岁）。采用髂嵴骨移植重建，并按照该方案进行修复（平均重建长度为8.7 cm），12例患者成功且无任何并发症。1例患者出现轻微并发症，由于移植骨与口腔相通，移植骨部分被吸收。该并发症并未妨碍牙种植体修复。另1例患者因口腔黏膜裂开及与口腔大量相通导致感染，移植骨完全丧失。6个月后再次进行了游离髂嵴移植重建。
科学证据表明，良性肿瘤切除后使用游离移植骨进行下颌骨重建是一种生物学上可持续的选择。提高良性肿瘤游离移植骨重建预后的关键因素是要有优质的软组织并避免与口腔相通。为此，在切除肿瘤前进行拔牙至关重要。
