Division of Maxillofacial Oncology and Reconstructive Surgery, John Peter Smith Health Network, Fort Worth, Texas, USA.
Department of Oral and Maxillofacial Surgery, Naval Medical Center San Diego, San Diego, California, USA.
Head Neck. 2024 Nov;46(11):2737-2743. doi: 10.1002/hed.27800. Epub 2024 May 10.
Fibula free flap reconstruction has revolutionized maxillofacial reconstruction. While immediate dental rehabilitation with dental implants and teeth has shown benefits, it remains uncommon, especially for patients with malignancy.
A retrospective cohort study at a single institution explored immediate dental rehabilitation in fibula flaps for patients with malignant disease. Thirteen patients with malignancies that underwent immediate fibula free flap reconstruction with dental implants and dental prosthesis were included with a minimum of 3-month follow-up.
Forty eight implants replaced 90 teeth in 13 patients. All implants were integrated at 3 months, with an overall success rate of 87.5%. Two patients experienced delayed (>3 months postoperatively) implant loss due to osteoradionecrosis and infection. Peri-mucositis occurred in three patients which resolved with treatment. Skin paddles were used in 11 patients and radiation therapy was not delayed for any patient.
With proper patient selection, diagnosis of malignancy and the need for osteocutaneous flap reconstruction does not exclude the ability to place immediate implants and deliver an immediate dental prosthesis in head and neck reconstruction.
游离腓骨瓣重建术使颌面重建发生了革命性变化。虽然即刻种植义齿和牙齿修复已经显示出了益处，但它仍然不常见，尤其是对于恶性肿瘤患者。
在一家机构进行的回顾性队列研究探讨了恶性疾病患者腓骨游离皮瓣即刻牙种植和义齿修复。纳入了 13 名接受即刻游离腓骨皮瓣重建术和牙种植体及义齿修复的恶性肿瘤患者，随访时间至少为 3 个月。
48 枚种植体替代了 13 名患者的 90 颗牙齿。所有种植体在 3 个月时均已整合，总体成功率为 87.5%。2 名患者因放射性骨坏死和感染发生了延迟（术后>3 个月）种植体脱落。3 名患者发生了黏膜周围炎，经治疗后得到缓解。11 名患者使用了皮瓣，没有患者因放射性治疗而延迟皮瓣成形术。
通过适当的患者选择，恶性肿瘤的诊断和需要进行骨皮瓣重建并不会排除在头颈部重建中即刻植入种植体和即刻义齿修复的能力。
