Department of maxillofacial surgery and odontology, Hospital "Saint Louis" of La Rochelle, rue du Docteur Albert-Schweitzer, 17000 La rochelle, France.
Department of maxillofacial and plastic surgery, Caen university hospital, 14000 Caen, Medicine faculty of Caen, university of Caen Basse Normandie, 14032 Caen cedex 5, France.
J Stomatol Oral Maxillofac Surg. 2019 Apr;120(2):167-171. doi: 10.1016/j.jormas.2018.09.004. Epub 2018 Oct 25.
It is recognized that the mandibular reconstruction with free flap allows for both functional and aesthetic restoration. The flap must be used for reconstruction of a smooth lower mandibular contour and also the alveolar bone to allow dental rehabilitation. The double-barrel fibula free flap does respond well to these imperatives, but it increases risk of vascular complications. To overcome these risks, we propose a single-barrel fibula free flap, positioned at the alveolar level and a customized 3D implant, designed by computer-assisted surgery, at the basilar level. The interest of the single-barrel fibula associated with a customized 3D implant compared to the double-barrel fibula free flap is twofold: it decreases the vascular risks associated with the plication of the second pedicle and allows patients to have a pedicle of greater length. It also allows them to have a good cortical bone placed in the alveolar bone to rehabilitate the mastication function.
人们认识到，游离皮瓣下颌骨重建既能实现功能重建，也能实现美学重建。皮瓣必须用于重建光滑的下颌轮廓和牙槽骨，以实现牙齿修复。双段腓骨游离皮瓣能够很好地满足这些要求，但会增加血管并发症的风险。为了克服这些风险，我们提出了一种单段腓骨游离皮瓣，置于牙槽骨水平，并使用计算机辅助手术设计定制的 3D 种植体，置于基底部。与双段腓骨游离皮瓣相比，单段腓骨联合定制 3D 种植体的优势有两点：它降低了与第二个蒂折叠相关的血管风险，并允许患者拥有更长的蒂。它还可以使患者获得良好的皮质骨置于牙槽骨中，以恢复咀嚼功能。
