Tarsitano Achille, Battaglia Salvatore, Ramieri Valerio, Cascone Piero, Ciocca Leonardo, Scotti Roberto, Marchetti Claudio
Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences (Head: Prof. C. Marchetti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Department of Biomedical and Neuromotor Sciences (Head: Prof. C. Marchetti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
J Craniomaxillofac Surg. 2017 Feb;45(2):330-337. doi: 10.1016/j.jcms.2016.12.006. Epub 2016 Dec 16.
Condylar reconstruction and replacement using alloplastic materials currently attracts much surgical interest. The major challenge is to functionally reconstruct the anatomical region; this is crucial in terms of correct mandibular function. The goal of the present study was to evaluate the clinical outcomes of and complications experienced by a series of oncological patients who underwent computer-aided design/computer-aided manufacturing (CAD/CAM) condylar reconstruction following resection-disarticulation of the mandible.
We included nine patients who underwent disarticulation resection surgery to treat benign and malignant mandibular tumors involving the condylar region. All resections preserved the articular meniscus and featured placement of a CAD/CAM reconstructive plate supporting a fibular, microvascular free flap. The head of the prosthetic condyle reproduced the anatomical morphology of the native condyle. Patients were clinically evaluated in terms of occlusion stability, mandibular functional recovery, static and dynamic pain, and preservation of the normal mandibular contour. Planning and postoperative computed tomography (CT) scans were superimposed to assess the accuracy of reconstruction.
No patient experienced plate exposure and, on direct clinical examination, no patient complained of joint pain. No patient developed plate loosening. No resorption of the glenoid fossa was evident when pre- and postoperative bone thicknesses were compared by CT. Preoperative occlusion was preserved in all dentate patients. One patient exhibited condylar displacement. In terms of reconstructive accuracy, the average postoperative deviation of the condyle from the preoperative position was 3.8 mm (range: 1.3-6.7 mm).
The clinical outcomes of our series of oncological patients who underwent reconstruction using CAD/CAM plates including condyles were encouraging. The utility of our protocol needs to be confirmed in larger patient series.
目前，使用异体材料进行髁突重建和置换引起了众多外科医生的兴趣。主要挑战在于对该解剖区域进行功能重建；这对于正确的下颌功能至关重要。本研究的目的是评估一系列接受下颌骨切除-关节离断术后采用计算机辅助设计/计算机辅助制造（CAD/CAM）髁突重建的肿瘤患者的临床结局及并发症情况。
我们纳入了9例接受关节离断切除术以治疗累及髁突区域的下颌骨良性和恶性肿瘤的患者。所有切除手术均保留了关节半月板，并采用了支撑腓骨游离微血管皮瓣的CAD/CAM重建钢板。假体髁突头部再现了天然髁突的解剖形态。对患者进行了临床评估，包括咬合稳定性、下颌功能恢复情况、静息和动态疼痛以及正常下颌轮廓的保留情况。将术前和术后的计算机断层扫描（CT）图像叠加，以评估重建的准确性。
没有患者出现钢板外露，直接临床检查时，也没有患者主诉关节疼痛。没有患者发生钢板松动。通过CT比较术前和术后的骨厚度时，未发现关节窝有明显吸收。所有有牙患者均保留了术前咬合。1例患者出现髁突移位。在重建准确性方面，术后髁突相对于术前位置的平均偏差为3.8毫米（范围：1.3 - 6.7毫米）。
我们这一系列采用包括髁突的CAD/CAM钢板进行重建的肿瘤患者的临床结局令人鼓舞。我们方案的实用性需要在更大规模的患者系列中得到证实。
