Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Head Neck. 2021 Sep;43(9):2623-2633. doi: 10.1002/hed.26731. Epub 2021 May 7.
This study virtually compares patient-specific fibular and scapular reconstructions for maxillectomies.
Nine maxillectomy defects were created on 10 maxillas and virtually reconstructed with patient-specific fibulas and scapulas. Reconstructions were compared for restoring midface cephalometrics, dental implantability, and pedicle length.
Of 90 maxillectomy defects, the vertically oriented scapula provided improved orbital floor and maxillary height reconstructions (p < 0.001), albeit at the cost of dental implantability compared to the fibula (p < 0.001). In two defects crossing the midline, the fibula, allowing for more osteotomies, provided improved maxillary projection. In the remaining three defects crossing the midline, the horizontally oriented scapula was comparable to the fibula. Fibular and scapular reconstructions were amenable for dental implantation and had similar pedicle lengths, although favoring scapula in extensive defects.
Fibular and scapular reconstructions of maxillectomy defects provide unique strengths. This virtual analysis can guide a goal-oriented reconstruction based on defect type and patient-specific goals.
本研究通过虚拟技术对比了腓骨和肩胛骨个体化重建在上颌骨切除术中的应用。
在 10 个上颌骨上共创建 9 个上颌骨切除缺损，并通过个体化腓骨和肩胛骨进行虚拟重建。对比分析重建效果，包括中面部正位测量、牙种植可行性和蒂长。
90 个上颌骨切除缺损中，垂直位肩胛骨可改善眶底和上颌高度重建（p<0.001），但与腓骨相比，牙种植可行性降低（p<0.001）。在 2 个中线穿过的缺损中，腓骨可进行更多截骨术，提供更好的上颌突出度。在另外 3 个中线穿过的缺损中，水平位肩胛骨与腓骨相当。腓骨和肩胛骨重建均适合牙种植，蒂长相似，但在广泛缺损中更倾向于使用肩胛骨。
腓骨和肩胛骨重建上颌骨切除缺损各有优势。这种虚拟分析可以根据缺损类型和患者的特定目标，指导有针对性的重建。
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