Special considerations in virtual surgical planning for secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous flap
Special considerations in virtual surgical planning for secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous flap
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DOI：
10.1016/j.bjps.2011.12.035
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发表时间：
2012-07-01
影响因子：
2.7
通讯作者：
Ow, Andrew
中科院分区：
文献类型：
--
作者：
Shen, Yi;Sun, Jian;Ow, Andrew
背景资料：本文介绍了我们的特殊考虑，在虚拟手术计划二次上颌重建血管腓骨骨肌皮瓣和我们的修订手术设计上颌reconstruction.Methods：11例不同的上颌缺损根据布朗的修订分类进行虚拟手术计划二次准确的重建。结果：在术前虚拟计划的指导下，采用腓骨截骨和复位导向模板，术中复制虚拟计划，对上颌骨进行重建，并根据对侧牙槽嵴的镜像或下颌牙弓和牙列的曲线，对不同水平分类的缺损，腓骨截骨以匹配上颌骨牙槽弓。在所有患者术中复制虚拟手术计划。分别将3例水平d2级缺损患者的腓骨截骨为4段，8例水平b-d1级缺损患者的腓骨截骨为3段。11例皮瓣成功率为100%。11名患者观察到良好的骨愈合和伤口闭合，并实现了清晰的言语。最大切口开度3.0 ~ 4.0cm。所有患者术后均能耐受常规饮食。所有患者术后面中部外观良好。结论：我们建议将Brown修订的上颌骨和面中部分类中的水平d级缺损根据是否涉及对侧尖牙分为两个亚型。在虚拟手术计划中的特殊考虑有助于用带血管的腓骨骨肌皮瓣进行精确的上颌骨重建。(C)2012年英国整形、重建和美容外科医生协会。由爱思唯尔有限公司出版。保留所有权利。
Background: This article describes our special considerations in virtual surgical planning for secondary maxillary reconstruction with vascularised fibular osteomyocutaneous flap and our revised surgical design for maxillary reconstruction.Methods: Eleven patients with different maxillary defects according to Brown's revised classification underwent virtual surgical planning for secondary accurate reconstruction. For different horizontal class defects, the fibular was osteomised to match the maxillary alveolar arch by using the mirror image of the contralateral alveolar ridge or the curve of the mandibular arch and dentition.Results: Maxillary reconstruction was performed with the guidance of preoperative virtual planning and using fibular osteotomy and reposition guide templates to replicate the virtual planning intra-operatively. Virtual surgical planning was replicated intra-operatively in all patients. The fibulae were osteotomised into four segments in three patients with the horizontal class d2 defect and three segments in eight patients with the horizontal class b-d1 defects, respectively. The overall success rate for 11 flaps was 100%. Good bony unions and wound closure were observed and intelligible speech was achieved in 11 patients. Maximum incisal opening ranged from 3.0 to 4.0 cm. All patients tolerated a regular diet postoperatively. Postoperative midfacial appearance was good in all patients.Conclusion: We recommend that the horizontal class d defect in Brown's revised classification of maxilla and midface be divided into two sub-types according to whether it involves the contralateral canine or not. Special considerations in virtual surgical planning are helpful to perform accurate secondary maxillary reconstruction with a vascularised fibular osteomyocutaneous flap. (C) 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.