Davies Rhodri, Cascarini Luke
The Royal London Hospital, Whitechapel, E1 1FR, London, UK.
Guy's Hospital, Great Maze Pond, SE1 9RT, London, UK.
J Oral Biol Craniofac Res. 2022 Sep-Oct;12(5):593-598. doi: 10.1016/j.jobcr.2022.07.003. Epub 2022 Jul 15.
Ablative surgery of the mandibular condyle poses a unique reconstructive challenge for many reasons. The condyle and it's relationship to the TMJ is a unique, complex, functional and aesthetically relevant piece of human anatomy. Resection may be required for both malignant and benign pathologies; each posing a differing set of surgical variables. Particularly in neoplastic processes, there must remain a certain degree of peri-operative flexibility with regards to the extent of the resection, and forethought to the requirement for post-operative radiotherapy; both of which further complicate choice of reconstructive option and surgical or prosthetic planning. The cases involved can often concern paediatric patients, and an additional aspect to be considered is that of growth potential. In this piece, we will discuss the indications for ablation and the techniques involved. We will elaborate on the reconstructive challenges specific to reconstructing the condyle in post-ablative cases. We will then describe and analyse the established reconstructive techniques; aiming to provide a balanced view on the advantages and disadvantages. Our focus will include autologous options such as vascularised and non-vascularised free tissue transfer, and the non-autologous options of custom and stock implants. We will also touch on distraction osteogenesis and ramus osteotomies. Lastly we will look to the future and consider possible innovative techniques which may become available to the surgeon.
下颌髁突的切除手术因多种原因带来了独特的重建挑战。髁突及其与颞下颌关节的关系是人体解剖结构中独特、复杂、具有功能且与美学相关的一部分。恶性和良性病变都可能需要进行切除；每种病变都带来不同的手术变量。特别是在肿瘤性病变过程中，在切除范围方面必须保持一定程度的围手术期灵活性，并预先考虑术后放疗的需求；这两者都会使重建方案的选择以及手术或假体规划更加复杂。所涉及的病例通常包括儿科患者，另一个需要考虑的方面是生长潜力。在本文中，我们将讨论切除的适应症以及所涉及的技术。我们将详细阐述在切除术后重建髁突所特有的重建挑战。然后我们将描述并分析已有的重建技术；旨在对其优缺点提供一个平衡的观点。我们的重点将包括自体选择，如带血管和不带血管的游离组织移植，以及定制和现成植入物的非自体选择。我们还将提及牵张成骨术和下颌支截骨术。最后，我们将展望未来并考虑外科医生可能会采用的创新技术。
