Grätz K W, Sailer H F, Haers P E, Oechslin C K
Department of Cranio-Maxillofacial Surgery, University Hospital Zurich, Switzerland.
Br J Oral Maxillofac Surg. 1996 Oct;34(5):379-85. doi: 10.1016/s0266-4356(96)90091-1.
Eleven patients underwent mandibular reconstruction with pedicled temporal muscle flaps combined with vascularised or free full thickness calvarial bone grafts. Six were primary and five secondary reconstructions. The indications were squamous cell carcinoma (n = 6), radio-osteonecrosis (n = 4), and gunshot wound (n = 1). Five patients also had endosseus implants, either simultaneously or delayed. The only major complications were necrosis of the whole calvarial bone (n = 1) and permanent facial nerve palsy (n = 1). The advantages of using full thickness calvarial bone are that it is thick enough to take an endosseous implant, morbidity is low, there is virtually no postoperative pain, the scar is invisible, and there is only one donor area for both hard and soft tissue. Transplantation of full thickness calvarial bone and temporal muscle is a viable alternative to an osseomyocutaneous microvascularised free flap for reconstruction of the mandible when the neck has been previously operated on or irradiated, and anastomosis may be critical.
11例患者采用带蒂颞肌瓣联合带血管蒂或游离全层颅骨骨移植进行下颌骨重建。其中6例为一期重建，5例为二期重建。适应证包括鳞状细胞癌（6例）、放射性骨坏死（4例）和枪伤（1例）。5例患者同时或延期进行了骨内种植体植入。仅出现了2例主要并发症，包括全层颅骨坏死（1例）和永久性面神经麻痹（1例）。使用全层颅骨骨的优点在于其厚度足以植入骨内种植体，发病率低，术后几乎无疼痛，瘢痕不可见，并且软硬组织仅有一个供区。当颈部先前已接受手术或放疗且吻合可能至关重要时，全层颅骨骨和颞肌移植是微血管游离骨肌皮瓣重建下颌骨的可行替代方案。
