Chen Xin-Ran, Zhang Shi-Long, Chen Lei, Li Jin-Chao, Jia Jun, Yu Zi-Li
State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration.
Dongfeng Stomatological Hospital, Hubei University of Medicine, Shiyan.
J Craniofac Surg. 2025 Jun 1;36(4):e415-e418. doi: 10.1097/SCS.0000000000010978. Epub 2024 Dec 4.
With the rapid advancement of digital and microsurgical techniques, immediate autologous bone grafting following resection of benign and malignant mandibular tumors has become a standard treatment. However, some patients are unable to undergo immediate autologous bone grafting due to various reasons. In such cases, titanium plate implantation (or combined with soft tissue free flap such as anterolateral thigh flap) serves as an alternative to prevent airway compression and maintain facial shape and function. This article reports a case of a patient, referred to as patient 1, who experienced a recurrence of mandibular leiomyosarcoma and was unable to undergo immediate autologous bone grafting. Instead, an immediate titanium plate implantation was chosen to restore the patient's facial contour and esthetics. Although this method addresses functional and esthetic issues in the short term, a high risk of titanium plate exposure, which is shown in patient 2, adversely affects life quality. After systematic evaluation, the decision was made to retain and continue using the original titanium plate and screws and perform autologous fibula flap transplantation to repair the mandibular defect. Surgical procedures included titanium plate removal and debridement, bilateral partial mandibular resection and osteoplasty, preparation of the free fibula flap, and placement with fixation using the original titanium plate. Postoperative follow-up showed successful flap healing without complications, and the patient was satisfied with her postoperative appearance. This innovative strategy, under strict indications, can reduce the financial burden on patients, maintain occlusal relationships, and significantly improve postoperative quality of life.
随着数字技术和显微外科技术的快速发展，良性和恶性下颌骨肿瘤切除术后立即进行自体骨移植已成为标准治疗方法。然而，由于各种原因，一些患者无法进行立即自体骨移植。在这种情况下，钛板植入（或联合游离软组织瓣如股前外侧皮瓣）可作为一种替代方法，以防止气道受压并维持面部外形和功能。本文报道了一例患者（称为患者1），其下颌平滑肌肉瘤复发且无法进行立即自体骨移植。取而代之的是选择立即进行钛板植入以恢复患者的面部轮廓和美观。尽管这种方法在短期内解决了功能和美观问题，但如患者2所示，钛板外露的高风险对生活质量产生了不利影响。经过系统评估，决定保留并继续使用原来的钛板和螺钉，并进行自体腓骨瓣移植以修复下颌骨缺损。手术步骤包括钛板取出和清创、双侧部分下颌骨切除和骨成形术、游离腓骨瓣制备，以及使用原来的钛板进行放置固定。术后随访显示皮瓣愈合成功且无并发症，患者对术后外观满意。在严格的适应症下，这种创新策略可以减轻患者的经济负担，维持咬合关系，并显著提高术后生活质量。
