Reconstruction using a three-dimensional orbitozygomatic skeletal model of titanium mesh plate and soft-tissue free flap transfer following total maxillectomy
Reconstruction using a three-dimensional orbitozygomatic skeletal model of titanium mesh plate and soft-tissue free flap transfer following total maxillectomy
复制标题
DOI：
10.1097/01.prs.0000130940.46400.7f
复制
发表时间：
2004-09-01
影响因子：
3.6
通讯作者：
Torii, S
中科院分区：
文献类型：
--
作者：
Nakayama, B;Hasegawa, Y;Torii, S
上颌骨切除后重建上颌骨的手术策略尚未得到规范。作者开发了一种利用钛网的三维眶颧骨模型进行上颌骨切除后的骨骼重建的技术。自1996年5月至2000年9月，对18例上颌骨恶性肿瘤患者行全上颌骨全切除术后，应用钛网模型联合软组织瓣进行修复。软组织游离组织瓣是一种传统的组织瓣，由两个皮桨组成，覆盖上颌骨缺损。其中一块皮瓣用作鼻侧壁，另一块皮瓣用于封闭腭部缺损。造模后，在眶内容物与游离皮瓣上缘之间植入钛网板，使其位于皮瓣前方。模型外侧固定于残留颧骨，内侧固定于鼻或额骨。用三到四针真皮缝合在钛网的底部边缘，形成一种凹形新瓣，使患者可以戴上义齿。18例种植体植入患者中，13例面部外观和口腔功能良好。这一手术防止了由于重力引起的眼球迟缓、面部畸形和腭部皮肤的下垂。5名患者(27.8%)发生了植入物暴露或感染，失去了使用假体的好处。然而，治疗并不需要完全移除植入物。在网状钢板两侧的软组织转移过程中保持足够的组织容量可能会将并发症发生率降至最低。钛网植入上颌骨切除后骨重建避免了骨移植的需要，可能对脆弱或老年患者特别有益。
The surgical strategy for maxillary reconstruction after maxillectomy has yet to be standardized. The authors developed a technique using a three-dimensional orbitozygomatic skeletal model of a titanium mesh for skeletal reconstruction after maxillectomy. From May of 1996 to September of 2000, 18 patients underwent reconstruction using the titanium mesh model in conjunction with a soft-tissue free flap following total maxillectomy for a maxillary malignancy. The soft-tissue free flap was conventional and consisted of two skin paddles to the maxillary defect. One skin paddle became the lateral nasal wall and the other was used to close the palatal defect. After modeling, the titanium mesh plate was implanted between the orbital contents and the upper edge of the free flap to lie over the front of the flap. The model was fixed to the residual zygoma laterally and to the nasal or frontal bone medially. The palatal skin paddle was anchored by three or four dermal stitches to the bottom edge of the titanium mesh to create a concave neopalate that allowed the patient to wear a denture. Thirteen of 18 patients who underwent implantation had good facial appearance and oral function. This procedure prevented lagophthalmos, facial deformity, and sagging of the palatal skin paddle caused by gravitational force. Five patients (27.8 percent) developed exposure or infection of the implant and lost the benefit of having the prosthesis. However, treatment did not require total removal of the implant. Maintaining adequate tissue volume during soft-tissue transfer on either side of the mesh plate may minimize the complication rate. Titanium mesh implantation for skeletal reconstruction after maxillectomy avoids the need for bone,grafting and may be especially beneficial in fragile or aged patients.