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下颌骨髁突骨软骨瘤:不同手术方法的适应证:7 例病例系列。

Osteochondroma of the mandibular condyle: Indications for different surgical methods: A case series of 7 patients.

机构信息

Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Italy.

Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Italy.

出版信息

J Craniomaxillofac Surg. 2021 Jul;49(7):584-591. doi: 10.1016/j.jcms.2021.04.007. Epub 2021 Apr 21.

Abstract

The aim of this study was to evaluate and discuss the long-term outcomes of patients with condylar osteochondroma managed through 3 different surgical techniques. Seven patients with condylar osteochondroma treated in the author's department from May 2012 to January 2019 were included in this retrospective study. Clinical evaluations (visual analogue scale for TMJ pain, jaw function, symmetry, and quality of life), maximum interincisal opening (MIO) and radiological findings were collected pre- and postoperatively. Other parameters assessed included tumour size and location; complications and follow-up. Radical condylectomy with immediate total joint alloplastic reconstruction was performed in 4 patients, local excision in 2 patients and low condylectomy with concomitant orthognathic surgery in 1 patient. During an average follow-up period of 40,8 months no clinical or radiographic signs of recurrence were found. Average MIO increased from 25,5mm to 39,5mm at the longest follow up, and all clinical evaluations were greatly improved. In conclusion, the described surgical techniques appear valuable in the treatment of condylar osteochondroma. Local excision is indicated in tumor involving less than half the surface of the condylar head; radical condylectomy with immediate alloplastic total joint reconstruction is indicated in gigantic lesion compromising the anatomical components and function of the joint. Orthognathic surgery procedures should be combined with tumor resection when correction of associated dentofacial deformities is indicated.

摘要

本研究旨在评估和讨论通过 3 种不同手术技术治疗髁突骨软骨瘤患者的长期疗效。回顾性分析 2012 年 5 月至 2019 年 1 月在作者所在科室接受治疗的 7 例髁突骨软骨瘤患者。收集术前和术后的临床评估(TMJ 疼痛、下颌功能、对称性和生活质量的视觉模拟评分)、最大开口度(MIO)和影像学发现。评估的其他参数包括肿瘤大小和位置、并发症和随访。4 例患者行根治性髁突切除术并即刻全关节假体重建,2 例患者行局部切除术,1 例患者行低位髁突切除术联合正颌手术。平均随访 40.8 个月,未发现临床或影像学复发迹象。平均 MIO 从术前的 25.5mm 增加到最长随访时的 39.5mm,所有临床评估均得到显著改善。总之,所描述的手术技术在治疗髁突骨软骨瘤方面具有重要价值。当肿瘤累及小于髁突头部一半的表面时,建议行局部切除术;当巨大病变累及关节解剖结构和功能时,建议行根治性髁突切除术并即刻行全关节假体重建。当存在相关的牙颌面畸形需要矫正时,应结合肿瘤切除术进行正颌手术。

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