Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom.
J Reconstr Microsurg. 2020 Jan;36(1):21-27. doi: 10.1055/s-0039-1694044. Epub 2019 Aug 9.
Appropriate reconstruction of the posterolateral mandible remains controversial. Both osseous and soft tissues are vital components for an overall successful outcome and are often combined in complex defects. Their respective effect on oromandibular function in the reconstruction of different degrees of mandibular defects has been less evaluated. This study aimed to compare patient-perceived oromandibular function in osseous and soft tissue-only reconstructions following posterolateral mandibular defects, defined as limited or extended.
A 10-year retrospective review of consecutive patients undergoing mandibular reconstructions of the posterolateral mandible were identified. Limited defects were defined as reaching from the ipsilateral parasymphysis to anterior of the coronoid (sparing insertion of muscles of mastication). Extended defects were defined as reaching from the ipsilateral parasymphysis to posterior of the coronoid (sacrificing the muscle insertions). Functional outcomes were assessed using the University of Washington Quality of Life questionnaire, version 4.
A total of 163 patients were identified, of which 41 patients had the particular posterolateral mandibular resections sought after. In 23 limited resections, there was no difference in functional outcome between osseous and soft tissue-only reconstructions. In 18 patients undergoing extended resections, osseous reconstructions demonstrated significantly better outcomes ( = 0.011). There were no significant differences in patient demographics between the groups.
Our study highlights the interest of soft tissue-only reconstructions of the posterolateral mandible. Limited resections seem not to benefit from complex osseous reconstruction for adequate function. Conversely, there is a noteworthy positive impact on functional outcomes in extended posterolateral mandibulectomies reconstructed with osseous tissue, compared with soft tissue only. Although a larger study is needed to identify a stronger relationship, these preliminary results could aid reconstructive decisions, particularly when considering patient morbidity.
后外侧下颌骨的适当重建仍然存在争议。骨组织和软组织都是整体成功结果的重要组成部分，并且经常在复杂的缺损中联合使用。它们在重建不同程度下颌骨缺损中的各自对口腔颌面部功能的影响尚未得到充分评估。本研究旨在比较后外侧下颌骨缺损后骨组织和软组织重建患者对口腔颌面部功能的感知，这些缺损被定义为局限性或扩展性。
对连续接受后外侧下颌骨下颌骨重建的患者进行了 10 年回顾性研究。局限性缺损定义为从同侧下颌联合到喙突的前侧（保留咀嚼肌的附着）。扩展性缺损定义为从同侧下颌联合到喙突的后侧（牺牲肌肉附着）。使用华盛顿大学生活质量问卷（第四版）评估功能结果。
共确定了 163 例患者，其中 41 例患者进行了后外侧下颌骨特定的切除术。在 23 例局限性切除中，骨组织和软组织重建之间的功能结果没有差异。在 18 例接受扩展切除的患者中，骨组织重建的结果明显更好（ = 0.011）。两组患者的人口统计学特征无显著差异。
我们的研究强调了后外侧下颌骨软组织重建的重要性。对于足够的功能，局限性切除似乎不需要复杂的骨组织重建。相反，与仅软组织重建相比，在扩展的后外侧下颌骨切除后用骨组织重建有显著的正功能结果。虽然需要更大的研究来确定更强的相关性，但这些初步结果可以辅助重建决策，特别是在考虑患者发病率的情况下。
