一日重建颌骨：上颌骨重建的最新技术
Jaw in a Day: State of the Art in Maxillary Reconstruction.
作者信息
Runyan Christopher M, Sharma Vishal, Staffenberg David A, Levine Jamie P, Brecht Lawrence E, Wexler Leonard H, Hirsch David L
机构信息
*Hansjörg Wyss Department of Plastic Surgery, New York University†Department of Prosthodontics, New York University College of Dentistry‡Department of Pediatrics, Memorial Sloan-Kettering Cancer Center§New York Head and Neck Institute, Northwell, Lenox Hill Hospital, New York, NY.
出版信息
J Craniofac Surg. 2016 Nov;27(8):2101-2104. doi: 10.1097/SCS.0000000000003139.
BACKGROUND
Reconstruction of maxillary defects following tumor extirpation is challenging because of combined aesthetic and functional roles of the maxilla. One-stage reconstruction combining osseous free flaps with immediate osseointegrated implants are becoming the standard for mandibular defects, and have similar potential for maxillary reconstruction.
METHODS
A woman with maxillary Ewing sarcoma successfully treated at age 9 with neoadjuvant chemotherapy, right hemimaxillectomy, and obturator prosthetic reconstruction presented for definitive reconstruction, complaining of poor obturator fit, and hypernasality. Her reconstruction was computer-simulated by a multidisciplinary team, consisting of left hemi-Lefort I advancement and right maxillary reconstruction with a free fibula flap with immediate osseointegrated implants and dental prosthesis.
RESULTS
Full dental restoration, midface projection, and oral fistula corrections were achieved in 1 operative stage using this approach.
CONCLUSIONS
This patient demonstrates a successful approach for maxillary reconstruction using computer-planned orthognathic surgery with free fibula reconstruction and immediate osseointegrated implants with dental prosthesis.
背景
由于上颌骨兼具美学和功能双重作用，肿瘤切除后上颌骨缺损的重建具有挑战性。一期重建将游离骨瓣与即刻骨整合种植体相结合正成为下颌骨缺损的标准治疗方法，并且在上颌骨重建方面具有类似的潜力。
方法
一名患有上颌骨尤因肉瘤的女性患者，9岁时接受新辅助化疗、右半上颌骨切除术和阻塞器假体重建后成功治愈，现因阻塞器贴合不佳和鼻音过重前来进行确定性重建。由多学科团队对其重建进行计算机模拟，包括左半勒福Ⅰ型截骨前移和使用带即刻骨整合种植体的游离腓骨瓣及牙修复体进行右上颌骨重建。
结果
采用该方法在1个手术阶段实现了全牙修复、面中份突出和口腔瘘修复。
结论
该患者展示了一种成功的上颌骨重建方法，即使用计算机规划的正颌手术联合游离腓骨重建以及即刻骨整合种植体和牙修复体。
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