口内入路下颌骨良性肿瘤切除同期自体骨移植修复重建术的临床研究

发布时间：2018-10-24 07:54

【摘要】：目的探讨采用口内入路切除下颌骨良性肿瘤同期自体骨移植修复重建术的临床疗效。方法 2009年1月-2012年9月,收治15例下颌骨良性肿瘤患者。其中男7例,女8例;年龄18~45岁,平均30岁。病理诊断为成釉细胞瘤11例,牙源性角化囊肿3例,黏液瘤1例。病变缺损部位按Urken’s CRBS分类:下颌骨同侧体部(B型)3例,升支(R型)3例,体部+升支(BR型)9例。手术均采用口内入路(1例因病变部位至乙状切迹平面,在耳前行辅助切口)。分别采用以计算机辅助设计/计算机辅助制造技术构建的下颌骨模型上弯制重建钛板(9例)或术中直接按颌骨形状弯制重建钛板(6例)。切除下颌骨肿瘤后将弯制重建钛板原位固定,根据骨缺损情况分别采用自体髂骨(11例)或血管化腓骨瓣(4例)移植修复。6例保留下齿槽神经。结果术后14例切口Ⅰ期愈合;1例发生植骨区感染,经相应处理后Ⅱ期愈合。15例均获随访,随访时间1~4年,平均2.5年。末次随访时,患者功能均恢复良好,无面神经损伤表现,余留牙列咬合关系基本维持术前状态;咀嚼功能满意;开口度30~35 mm,平均33 mm;吞咽及语言功能正常。口外仅有辅助切口及穿颊器轻微瘢痕,患者对面部外形满意。6例保留下齿槽神经患者术后下唇麻木症状缓解。随访期间均无复发。结论经口内入路切除下颌骨良性肿瘤同期行自体骨植骨修复重建术后面部无明显瘢痕,几乎不损伤面神经,外形恢复良好,是可靠的美容性手术入路和手术重建方案。
[Abstract]:Objective to investigate the clinical effect of intraoral resection of benign mandibular tumors with autogenous bone graft. Methods from January 2009 to September 2012, 15 patients with benign mandibular tumors were treated. There were 7 males and 8 females with an average age of 30 years (1845 years). There were 11 cases of ameloblastoma, 3 cases of odontogenic keratocyst and 1 case of myxoma. According to Urken's CRBS classification, there were 3 cases of ipsilateral body (type B), 3 cases of ascending branch (R type) and 9 cases of ascending branch of body (BR type). Intraoral approach was used in all cases (1 case was assisted incision before ear operation due to lesion site to sigmoid notch plane). The mandibular model was constructed by computer aided design (CAD) / computer-aided manufacturing (CAD / CAM). The mandibular model was reconstructed with titanium plate (9 cases) or the titanium plate was bent directly according to the shape of mandible (6 cases). After the mandibular tumor was resected, titanium plate was fixed in situ, and autogenous iliac bone (n = 11) or vascularized fibula flap (n = 4) were used to repair the bone defect, and the inferior alveolar nerve was preserved in 6 cases. Results there were 14 cases of primary wound healing, 1 case of infection of bone graft area, and 15 cases of second stage healing after corresponding treatment. The follow-up time was 1 ~ 4 years with an average of 2.5 years. At the last follow-up, all the patients recovered well, no facial nerve injury appeared, the occlusion relationship of residual dentition was basically in the preoperative state, the masticatory function was satisfactory, the opening degree was 30 ~ 35 mm, the average swallowing was 33 mm; and the speech function was normal. The patients were satisfied with facial appearance. 6 patients with inferior alveolar nerve were relieved of lower lip numbness after operation. No recurrence occurred during follow-up. Conclusion Transoral resection of benign mandibular tumors with autogenous bone graft at the same time has no obvious scar, almost no injury to facial nerve, and good shape recovery. It is a reliable cosmetic approach and reconstruction plan.
【作者单位】：浙江大学医学院附属第一医院口腔科;浙江大学医学院附属第一医院肿瘤科;
【基金】：浙江省卫生厅基金资助项目(N20110323)~~
【分类号】：R739.82

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