Nandra Baljeet, Fattahi Tirbod, Martin Tim, Praveen Prav, Fernandes Rui, Parmar Sat
Department of Oral and Maxillofacial Surgery, University Hospital Birmingham, England, United Kingdom.
Department of Oral and Maxillofacial Surgery, University of Florida, Jacksonville, Florida.
Craniomaxillofac Trauma Reconstr. 2017 Jun;10(2):117-122. doi: 10.1055/s-0036-1597583. Epub 2017 Feb 7.
Bony reconstruction of the mandible after surgical resection results in improved rehabilitation and aesthetics. Composite tissue transfer has transformed reconstruction, particularly in patients who have received radiotherapy. However, there is morbidity related to free tissue transfer. Free nonvascularized bone grafts have much lower morbidity. Surgeons believe that free bone grafts greater than 6.0 cm are prone to failure. The aims of this study was to assess whether bone grafts greater than 6.0 cm in length have a high risk of failure. A retrospective study was performed on all patients who had free bone grafts greater than 6.0 cm in length at Birmingham, UK, and Florida, the United States. None of the patients received radiotherapy. A total of 14 patients had undergone bone grafts for mandibular defects greater than 6.0 cm in length; 13 of the bone grafts were successful. Of these 13, none were infected and there was radiographic evidence of bony union. Some of the patients have been dentally rehabilitated with implants. Contrary to much of the literature and many surgeons belief, our study has shown that long mandibular defects (>6.0 cm) are not a contraindication to the use of free bone grafts. Key principles to achieve success are discussed in this article.
手术切除后下颌骨的骨重建可改善康复效果和美观度。复合组织移植改变了重建方式，尤其是在接受过放疗的患者中。然而，游离组织移植存在相关并发症。游离非血管化骨移植的并发症要低得多。外科医生认为，长度大于6.0厘米的游离骨移植易于失败。本研究的目的是评估长度大于6.0厘米的骨移植是否具有较高的失败风险。对英国伯明翰和美国佛罗里达州所有接受过长度大于6.0厘米游离骨移植的患者进行了一项回顾性研究。所有患者均未接受放疗。共有14例患者接受了长度大于6.0厘米的下颌骨缺损骨移植；其中13例骨移植成功。在这13例中，无一例感染，且有影像学证据显示骨愈合。部分患者已通过植入物进行了牙齿修复。与许多文献及众多外科医生的观点相反，我们的研究表明，长节段下颌骨缺损（>6.0厘米）并非游离骨移植的禁忌证。本文讨论了取得成功的关键原则。
