Wang Yujiao, Ma Dan, Li Yun, Zhang Chunyi, Yang Yaowu, Wu Wei
From the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China.
Plast Reconstr Surg Glob Open. 2024 Mar 4;12(3):e5644. doi: 10.1097/GOX.0000000000005644. eCollection 2024 Mar.
The study aimed to describe our experience in using endoscopic procedures to aid hemi-mandibular reconstruction with bone flaps through transoral approach.
Five patients with huge benign mandibular tumors underwent transoral mandibulectomy and hemi-mandibular reconstruction, using endoscopy. Facial symmetry, occlusion, bone healing, and mandibular similarity were all evaluated postoperatively. The paired-samples test was used to compare quantitative data, and a value less than 0.05 was considered a significant difference.
All five patients who received transoral mandibular surgery recovered in terms of TMJ functionality, facial symmetry, and aesthetic results. Endoscopy monitored and ensured that bone flaps were correctly connected and fixed. The accuracy of endoscopy-guided mandibular reconstruction was confirmed by quantitative examination for four cases, which revealed no statistically significant variations between postoperative CT analysis and preoperative virtual surgical planning data.
Endoscopy-assisted virtual surgery may resolve concerns with transoral hemi-mandibular reconstruction and broaden indications for mini-invasive mandibular reconstruction. However, only patients with benign mandibular tumors were included in our study, so surgeons should be very cautious if applying this technique to malignant lesions or bony tumors invading soft tissues.
本研究旨在描述我们使用内镜手术经口入路辅助带骨瓣的半侧下颌骨重建的经验。
5例巨大下颌骨良性肿瘤患者接受了经口下颌骨切除术及半侧下颌骨重建，术中使用了内镜。术后对面部对称性、咬合关系、骨愈合情况及下颌骨相似度进行了评估。采用配对样本检验比较定量数据，P值小于0.05被认为有显著差异。
所有5例接受经口下颌骨手术的患者在颞下颌关节功能、面部对称性及美学效果方面均恢复良好。内镜监测并确保了骨瓣的正确连接和固定。4例患者的定量检查证实了内镜引导下颌骨重建的准确性，术后CT分析与术前虚拟手术规划数据之间无统计学显著差异。
内镜辅助虚拟手术可能解决经口半侧下颌骨重建的相关问题，并拓宽微创下颌骨重建的适应证。然而，我们的研究仅纳入了下颌骨良性肿瘤患者，因此外科医生在将该技术应用于恶性病变或侵犯软组织的骨肿瘤时应非常谨慎。
