A Prospective Analysis of Bony versus Soft-Tissue Reconstruction for Posterior Mandibular Defects
A Prospective Analysis of Bony versus Soft-Tissue Reconstruction for Posterior Mandibular Defects
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DOI：
10.1097/prs.0b013e3181d62aef
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发表时间：
2010-05-01
影响因子：
3.6
通讯作者：
Yu, Peirong
中科院分区：
文献类型：
--
作者：
Hanasono, Matthew M.;Zevallos, Jose P.;Yu, Peirong
背景资料：虽然用游离骨瓣重建下颌前部肿瘤缺损被认为是标准的治疗方法，但对后部缺损的最佳重建仍存在争议。作者的目标是比较结果使用血管化骨瓣或软组织游离皮瓣后方下颌reconstruct.Methods：数据收集前瞻性的74例患者接受后方下颌骨切除术，包括髁状突。结果：24例患者进行血管化骨瓣重建和50例患者进行软组织游离皮瓣重建。接受血管化骨瓣重建的患者明显比接受软组织游离瓣重建的患者年轻（分别为47岁和62岁; p = 0.0001），并且美国麻醉医师协会分级较低（分别为2.6和3.1; p = 0.001）。在总手术时间、重症监护室住院时间或住院时间方面没有显著差异。接受血管化骨瓣重建的患者的并发症发生率为33%，接受软组织游离瓣重建的患者为38%（p = 0.70）。带血管骨瓣重建患者的平均张口度为39.8 mm，软组织游离瓣重建患者为46.4 mm（p = 0.09）。对于血管化骨瓣重建和软组织游离瓣重建，下颌向切除侧的偏斜平均为1.2 mm和5.3 mm（p = 0.02）。两组耐受的机械饮食类型无显著差异（p = 0.83）。结论：经过仔细选择，下颌后牙切除术后，血管化骨瓣或软组织游离瓣可获得良好的重建效果。在合适的患者中，带血管蒂骨瓣重建可能会导致更好的术后咬合。（Plast。重建125：1413，2010）。
Background: Although reconstruction of anterior mandibular oncologic defects with bony free flaps is considered the standard method of treatment, the optimal reconstruction of posterior defects is controversial. The authors' goal was to compare outcomes using either a vascularized bone flap or a soft-tissue free flap for posterior mandibular reconstruction.Methods: Data were collected prospectively on 74 patients undergoing posterior mandibular resection including the condyle.Results: Twenty-four patients underwent vascularized bone flap reconstruction and 50 patients underwent soft-tissue free flap reconstruction. Patients undergoing vascularized bone flap reconstruction were significantly younger than those undergoing soft-tissue free flap reconstruction (47 versus 62 years, respectively; p = 0.0001) and had a lower American Society of Anesthesiologists class (2.6 versus 3.1, respectively; p = 0.001). There were no significant differences in total operative time, intensive care unit stay, or hospital stay. The complication rate was 33 percent for patients receiving vascularized bone flap reconstructions and 38 percent for patients receiving soft-tissue free flap reconstruction (p = 0.70). Mouth opening averaged 39.8 mm for patients with vascularized bone flap reconstructions and 46.4 mm for patients with soft-tissue free flap reconstructions (p = 0.09). Jaw deviation toward the resection side averaged 1.2 mm for vascularized bone flap reconstructions and 5.3 mm for soft-tissue free flap reconstructions (p = 0.02). There was no significant difference in the type of mechanical diet tolerated by either group (p = 0.83).Conclusions: With careful selection, good reconstructive results after posterior mandibular resection can be achieved with vascularized bone flap or soft-tissue free flaps. In appropriate candidates, vascularized bone flap reconstruction may result in better postoperative occlusion. (Plast. Reconstr. Surg. 125: 1413, 2010.)