Zhang Wen-Bo, Yu Yao, Mao Chi, Wang Yang, Guo Chuan-Bin, Yu Guang-Yan, Peng Xin
Attending Doctor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
J Oral Maxillofac Surg. 2019 Sep;77(9):1915-1927. doi: 10.1016/j.joms.2019.03.014. Epub 2019 Mar 23.
Zygomatic complex defects after extensive maxillectomy can cause severe esthetic and functional deformities. Patient-specific titanium mesh fabricated using a computer-assisted technique is a promising method for such midface reconstruction. The aim of this study was to evaluate the application and clinical outcomes of this technique.
This was a retrospective study that included 9 patients with zygomatic complex defects after extensive maxillectomy from 2015 through 2017 at the authors' institution. A 3-dimensional stereo model was obtained based on mirror images of the unaffected side to fabricate a patient-specific titanium mesh using computer-assisted design and manufacturing. Titanium mesh was used to restore the contour of the zygomatic complex with free flap reconstruction after tumor resection. Anterolateral thigh flaps were used in 8 cases and a myocutaneous fibula flap was used in 1 case. Symmetry of the zygomatic complex was evaluated by measuring the zygomatic eminence on the postoperative computed tomogram, and complications were recorded during follow-up visits. Facial symmetry was self-evaluated and scored.
Mean duration for follow-up was 27.3 months (range, 15 to 39 months). Mean deviation of the zygomatic eminence between the reconstructed and unaffected sides was 1.4 ± 0.5 mm. No significant difference was noted in the zygomatic eminence between the reconstructed and unaffected sides (P = .591). Titanium mesh exposure occurred in only 1 patient after radiotherapy. There were no other remarkable complications. All patients were satisfied with their postoperative facial symmetry.
Patient-specific titanium mesh fabricated using a computer-assisted technique was an alternative option for extensive zygomatic complex reconstruction, resulting in acceptable clinical outcomes. A study with a larger sample and long-term follow-up is needed for the observation of long-term outcomes and risk of titanium mesh-related complications.
广泛上颌骨切除术后的颧骨复合体缺损可导致严重的美观和功能畸形。使用计算机辅助技术制作的个性化钛网是一种用于此类面中部重建的有前景的方法。本研究的目的是评估该技术的应用及临床效果。
这是一项回顾性研究，纳入了2015年至2017年在作者所在机构接受广泛上颌骨切除术后出现颧骨复合体缺损的9例患者。基于未受影响侧的镜像获得三维立体模型，采用计算机辅助设计与制造来制作个性化钛网。肿瘤切除后，使用钛网通过游离皮瓣重建来恢复颧骨复合体的轮廓。8例使用股前外侧皮瓣，1例使用腓骨肌皮瓣。通过术后计算机断层扫描测量颧骨突出度来评估颧骨复合体的对称性，并在随访期间记录并发症。患者对面部对称性进行自我评估并评分。
平均随访时间为27.3个月（范围15至39个月）。重建侧与未受影响侧颧骨突出度的平均偏差为1.4±0.5毫米。重建侧与未受影响侧的颧骨突出度无显著差异（P = 0.591）。仅1例患者在放疗后出现钛网外露。无其他明显并发症。所有患者对术后面部对称性均满意。
使用计算机辅助技术制作的个性化钛网是广泛颧骨复合体重建的一种替代选择，临床效果可接受。需要进行更大样本量和长期随访的研究来观察长期效果及钛网相关并发症的风险。
