Fellow Student, Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India.
Professor, Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India.
J Prosthet Dent. 2024 Jul;132(1):270-277. doi: 10.1016/j.prosdent.2022.06.001. Epub 2022 Jul 11.
Several mandibular defect classifications after oncological resection have been proposed with no universal acceptance among surgeons and prosthodontists. Established criteria for describing these mandibulectomy defects are lacking.
The purpose of this systematic review was to analyze the classification systems of mandibular defects available in the scientific literature, provide a critical appraisal, and identify the criteria necessary for a universal description of mandibular discontinuity defects.
An electronic search of the English language literature between 1971 and 2020 was performed on 2 electronic databases (PubMed and Cochrane Library). The search was conducted using MeSH terms and free text words: Mandible neoplasm AND Mandibular reconstruction OR Mandible resection OR Mandible defect AND classification, followed by the application of inclusion and exclusion criteria. Studies describing the classification of osteoradionecrosis of the mandible, mandibular fracture, impacted mandibular third molar, and mandibular endodontic or periodontal treatment were not included. The full texts of selected articles were reviewed in depth to provide a critical appraisal. The various descriptive factors of each classification system were tabulated to identify criteria suitable for the universal description of mandibular discontinuity defects.
The electronic search yielded a total of 239 titles and abstracts. Of these, 52 titles relevant to the review were identified by the 2 reviewers independently. Those studies that did not match the predetermined inclusion criteria and duplicates were excluded. By reviewing the 21 selected studies and applying exclusion criteria, 12 studies were selected for full-text reading. A manual search in the references of the selected publications was performed, which yielded 1 additional article that satisfied the inclusion criteria. Thus, a total of 13 full-text articles were included in the final review. After further qualitative analysis and tabulation of relevant information from selected classification systems, the 8 descriptive criteria and a pyramidal hierarchical chart were proposed that included the extent of bony defect, soft tissue defect, dental status, mandibular function, neurological status, condyle status, type of reconstruction, and combined resection.
The spectrum of patients with mandibulectomy defects following resection varies greatly. The question of the most ideal classification system remains unresolved. Eight different criteria for the description of mandibular discontinuity defects and the pyramidal hierarchical chart proposed will allow surgeons and prosthodontists to better communicate and conceptualize an individualized surgical and prosthetic treatment plan.
在肿瘤切除后，已经提出了几种下颌骨缺损分类，但外科医生和修复医生之间并未达成普遍共识。目前缺乏描述这些下颌骨切除术缺陷的既定标准。
本系统评价的目的是分析科学文献中下颌骨缺损分类系统，进行批判性评估，并确定下颌骨连续性缺损通用描述所需的标准。
在 2 个电子数据库（PubMed 和 Cochrane Library）中进行了 1971 年至 2020 年期间的英文文献电子搜索。使用 MeSH 术语和自由文本词进行搜索：下颌骨肿瘤和下颌骨重建或下颌骨切除术或下颌骨缺损和分类，然后应用纳入和排除标准。未包括描述下颌骨放射性骨坏死、下颌骨骨折、下颌第三磨牙阻生、下颌牙髓或牙周治疗的分类的研究。详细审查所选文章的全文以进行批判性评估。将各分类系统的各种描述性因素制表，以确定适合下颌骨连续性缺损通用描述的标准。
电子搜索共产生了 239 个标题和摘要。由 2 位评审员独立识别出其中 52 个与综述相关的标题。那些不符合预定纳入标准和重复的研究被排除在外。通过审查 21 篇选定的研究并应用排除标准，有 12 篇研究被选作全文阅读。在选定出版物的参考文献中进行了手动搜索，又找到了 1 篇符合纳入标准的文章。因此，共有 13 篇全文文章纳入最终综述。经过进一步的定性分析和从选定分类系统中相关信息的制表，提出了 8 个描述性标准和一个金字塔式层次图表，包括骨缺损程度、软组织缺损、牙齿状况、下颌功能、神经状态、髁突状态、重建类型和联合切除术。
接受切除术后下颌骨缺损患者的情况差异很大。最理想的分类系统的问题仍然没有得到解决。提出的 8 个下颌骨连续性缺损描述标准和金字塔式层次图表将使外科医生和修复医生能够更好地沟通和构思个体化的手术和修复治疗计划。
