Uppal Nugdeep, Breik Omar, Higginson James, Goodrum Heather, Koria Hitesh, Edmondson Stefan, Idle Matthew, Praveen Prav, Martin Timothy, Parmar Sat
Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2TH UK.
Maxillofacial Prosthetics Laboratory, Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, UK.
J Maxillofac Oral Surg. 2024 Dec;23(6):1379-1390. doi: 10.1007/s12663-023-02065-5. Epub 2023 Dec 7.
Reconstruction of mandibular disarticulation defects is a challenging area of head and neck surgery, with a variety of options available for replacement of the condylar head. The gold standard is autogenous reconstruction of the condyle-ramus unit. The use of a prosthetic condylar head is controversial, but in challenging cases, and those with a likely poor prognosis it may be considered and can achieve a good functional result. The objective of this study is to evaluate the outcomes of its use in a high volume head and neck reconstructive unit.
A retrospective analysis of all patients treated at the Queen Elizabeth Hospital, Birmingham who underwent mandibular disarticulation resections and prosthetic condylar reconstruction from January 2008 to December 2019 were included.
This retrospective review included 25 patients; 16 for malignant disease (16), osteoradionecrosis (4), osteomyelitis (2), medication related osteonecrosis (1), and secondary reconstruction(2). Free flap reconstruction was performed in 23 cases; 18 bony composite free flaps, 3 patients required double flap reconstruction, and 2 underwent soft tissue flaps only. Mean follow up was 43 months. Prosthesis related complications were encountered in 6 patients, all malignant cases. Four prosthetic condyles required removal due to recurrent infections and glenoid fossa perforation, This appeared to be related to significant surrounding dead space, and limited bony reconstruction. Rate of complications was lowest for non-malignant cases, and patients who had concurrent bony reconstruction extending up the ascending ramus. Functional outcomes were good with majority of patients having a balanced occlusion and oral intake.
Prosthetic condyle outcomes are best when concurrent bony free flap reconstruction is performed with ascending ramus reconstruction. Avoid prosthetic condyles in cases where the articular disc is removed, and cases where a large amount of dead space is expected around the prosthesis. Careful attention to occlusal factors and vertical support of the reconstruction plate can lead to good functional outcomes. A review of the literature and potential future advances is also presented.
下颌关节离断缺损的重建是头颈外科中具有挑战性的领域，有多种可用于替代髁突头部的方法。金标准是自体髁突-升支单位重建。使用人工髁突头部存在争议，但在具有挑战性的病例以及预后可能较差的病例中，可以考虑使用，并且可以取得良好的功能效果。本研究的目的是评估在一个高容量头颈重建单位中使用它的结果。
对2008年1月至2019年12月在伯明翰伊丽莎白女王医院接受下颌关节离断切除术和人工髁突重建的所有患者进行回顾性分析。
这项回顾性研究纳入了25例患者；其中16例为恶性疾病，4例为放射性骨坏死，2例为骨髓炎，1例为药物相关性骨坏死，2例为二次重建。23例患者进行了游离皮瓣重建；18例为骨复合游离皮瓣，3例患者需要双皮瓣重建，2例仅接受了软组织皮瓣。平均随访时间为43个月。6例患者出现了与假体相关的并发症，均为恶性病例。由于反复感染和关节窝穿孔，4个人工髁突需要取出，这似乎与大量周围死腔和有限的骨重建有关。非恶性病例以及同时进行升支骨重建的患者并发症发生率最低。功能结果良好，大多数患者咬合平衡且能经口进食。
当同时进行骨游离皮瓣重建和升支重建时，人工髁突的效果最佳。在切除关节盘的病例以及预计假体周围有大量死腔的病例中避免使用人工髁突。仔细关注咬合因素和重建板的垂直支撑可导致良好 的功能结果。还介绍了文献综述和潜在的未来进展。
