Patel S G, Deshmukh S P, Savant D N, Bhathena H M
Plastic & Reconstructive Surgery Service, Tata Memorial Hospital, Bombay, India.
J Oral Maxillofac Surg. 1996 Jun;54(6):698-703; discussion 703-4. doi: 10.1016/s0278-2391(96)90685-0.
The current study was undertaken to assess the functional deficit after hemiresection of the mandible and to determine whether lateral segment resection with reconstruction was a functionally superior alternative in the management of patients suffering from alveolobuccal cancer.
Eighty-three patients were assigned to one of two main groups: Group I, hemiresection of the mandible (n = 47), and group II, lateral segment defects (n = 36). Functional assessment of patients included subjective evaluation of overall well-being, feeding, and cosmesis, as well as objective assessment of mastication, speech, and cosmesis. Mean scores for each of these categories were compared across groups using the Duncan Multiple Range Test with .01 confidence intervals.
Subjective assessment of overall well-being, feeding, and cosmesis did not yield statistically significant differences between groups. Objective evaluation of mastication showed significantly better function after hemiresection in dentate patients as compared with their edentulous counterparts. However, masticatory scores for hemimandibulectomy patients with intact residual dentition were not significantly different from those for patients whose lateral segmental defects had been reconstructed. Although objective cosmetic scores for reconstruction of lateral segment defects were significantly better than those for hemiresection of the mandible, most patients in the latter group accepted the resultant deformity as a consequence of their treatment and did not let it affect their routine activities.
Until functional results in patients undergoing lateral segmental resection for alveolobuccal cancer can be improved by better prosthetic techniques, hemiresection of the mandible remains a simple, safe, reliable, and cost-effective option that produces acceptable postoperative function.
进行本研究以评估下颌骨半切除术后的功能缺陷，并确定在治疗牙槽颊癌患者时，带重建的外侧节段切除是否在功能上是更优的选择。
83例患者被分为两个主要组之一：第一组，下颌骨半切除（n = 47），第二组，外侧节段缺损（n = 36）。对患者的功能评估包括对总体健康状况、进食和美容的主观评价，以及对咀嚼、言语和美容的客观评估。使用置信区间为0.01的邓肯多重极差检验对各组中这些类别的平均得分进行比较。
在总体健康状况、进食和美容的主观评估中，两组之间未产生统计学上的显著差异。咀嚼的客观评估显示，有牙患者下颌骨半切除术后的功能明显优于无牙患者。然而，保留完整残余牙列的半侧下颌骨切除患者的咀嚼得分与外侧节段缺损已重建患者的得分无显著差异。尽管外侧节段缺损重建的客观美容得分明显优于下颌骨半切除，但后一组中的大多数患者接受了因治疗导致的畸形，且未让其影响日常活动。
在通过更好的修复技术改善牙槽颊癌外侧节段切除患者的功能结果之前，下颌骨半切除仍然是一种简单、安全、可靠且具有成本效益的选择，能产生可接受的术后功能。
