Guhan B Bala, Krishnaswamy Vinod Krishna, Karthikeyan G R, Mohan A Mathan
Department of Oral and Maxillofacial Surgery and Cleft and Craniofacial Reconstructive Surgery, Karpaga Vinayaga Institute of Medical and Dental Sciences, Chengalpet, Chennai, Tamil Nadu, India.
Saveetha Institute of Oral Cancer, Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Vellapanchavadi, Chennai, Tamil Nadu, India.
Natl J Maxillofac Surg. 2022 Jan-Apr;13(1):143-146. doi: 10.4103/njms.NJMS_133_20. Epub 2022 Apr 20.
Mandibular resections decision is one of the most important steps in oral cavity malignant or nonmalignant lesions associated with the mandible. The role of mandibular reconstruction is not only for cosmesis, but it is also indicated for functional rehabilitation such as swallowing, phonetics, and for facial symmetrical. Even though the free tissue transfer is considered a gold standard for mandibular reconstruction, the importance of nonvascularized bone grafts (NVBGs) such as fibula, calvarium, rib, sternum, and iliac are still persisting in mandibulectomies condition like patient who have not taken radiotherapy or not willing to undergo radiotherapy or not fit for free tissue transfer and provides a good contour of mandibular replacement. The success rate of NVBG depends upon patient selection, preoperative planning, and meticulous nursing care. Addition to NVBG, regional flaps such as pectoralis major myocutaneous (PMMC) flap will help in soft-tissue replacement of the defect as well as it will help in the situation where primary closure and airtight closure is not possible. This case report will discuss in detail about the management of anterior segmental mandibulectomy due to oncological resection and reconstruction with NVBG with fibula and PMMC.
下颌骨切除术的决策是下颌骨相关口腔恶性或非恶性病变治疗中最重要的步骤之一。下颌骨重建的作用不仅在于美容，还适用于吞咽、语音等功能康复以及面部对称。尽管游离组织移植被认为是下颌骨重建的金标准，但非血管化骨移植（NVBG）如腓骨、颅骨、肋骨、胸骨和髂骨在未接受放疗、不愿接受放疗或不适合游离组织移植的下颌骨切除病例中仍具有重要意义，并且能提供良好的下颌骨替代轮廓。NVBG的成功率取决于患者选择、术前规划和精心的护理。除了NVBG，局部皮瓣如胸大肌肌皮瓣（PMMC）有助于缺损的软组织替代，也有助于无法进行一期缝合和气密性缝合的情况。本病例报告将详细讨论因肿瘤切除导致的下颌骨前段切除术以及使用腓骨和PMMC进行NVBG重建的治疗方法。
