牵张成骨术与定制颞下颌关节假体在大型下颌骨缺损重建中的应用——病例报告
Distraction Osteogenesis and Customized Temporomandibular Joint Prosthesis in the Reconstruction of a Large Mandibular Defect - A Case Report.
作者信息
Cavalcante Weber Ceo, Espinheira Paula Rizerio D'Andrea, Sardinha Sandra de Cássia Santana, Rodrigues Daniel Barros, Ramalho Luciana M Pedreira
机构信息
Department of Oral and Maxillofacial Surgery, Federal Bahia University, Salvador, Bahia, Brazil.
Department of Propedeutics and Clinical, Federal Bahia University, Salvador, Bahia, Brazil.
出版信息
Ann Maxillofac Surg. 2021 Jan-Jun;11(1):187-190. doi: 10.4103/ams.ams_266_18. Epub 2021 Jul 24.
THE RATIONALE
Mandibular resections involve esthetic and functional impairment and impose a challenge during the reconstruction. This case report is a successful reconstruction with distraction osteogenesis (DO) and customized temporomandibular joint (TMJ) prosthesis.
PATIENT CONCERNS
A 51-year-old male patient presented with a complaint of facial asymmetry, mastication, and speech difficulties.
DIAGNOSIS
As the patient had undergone a hemimandibulectomy procedure 20 years ago, clinical examination showed facial asymmetry. Radiographic examination exhibited the defect and a radiopaque image representing Kirschner's wire.
TREATMENT
DO by bone transport was performed, followed by dental implant and TMJ prosthesis placement.
OUTCOMES
DO is a viable treatment option in resections, even when the defect was generated by an ancient injury. The follow-up is around 7 years after the osteogenic distraction, with no complaints and functional capacity.
TAKE-AWAY LESSONS: The major challenge in mandibular reconstructions through DO is to reproduce the curve of the arch.
原理
下颌骨切除术会导致美观和功能受损，在重建过程中是一项挑战。本病例报告是一例采用牵张成骨术（DO）和定制颞下颌关节（TMJ）假体进行成功重建的案例。
患者情况
一名51岁男性患者，主诉面部不对称、咀嚼和言语困难。
诊断
由于该患者20年前接受过半侧下颌骨切除术，临床检查显示面部不对称。影像学检查显示了缺损以及代表克氏针的不透射线影像。
治疗
采用骨运输法进行牵张成骨术，随后植入牙种植体并放置TMJ假体。
结果
即使缺损是由陈旧性损伤造成的，牵张成骨术在切除术中也是一种可行的治疗选择。成骨牵张术后随访约7年，患者无不适且功能良好。
经验教训
通过牵张成骨术进行下颌骨重建的主要挑战在于重现牙弓曲线。
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