上颌窦癌上颌骨全切除即刻中空充填式赝复体修复

Rehabilitation by hollow obturator prosthesis immediately after total maxillectomy for malignant tumor

目的探讨上颌窦癌上颌骨全切除后即刻中空充填式赝复体修复缺损的可行性和临床效果。方法13例T3-4aNOM0上颌窦癌患者，术前根据鼻窦三维计算机断层摄影术（three dimention—CT，3D—CT）重建，形成三维立体实物模型；应用Surgicare5．0软件模拟外科手术切除边界，形成计算机三维立体赝复体模型。依据计算机三维立体模型及患者术前印模，使用甲基丙烯酸树脂快速精确制作中空充填式赝复体，底部附带牙齿。上颌骨全切除术毕即刻完成置入。术后1、3、6个月定期门诊复查，人工测量面容、语音清晰度测定及调查问卷评估临床效果，差异比较采用配对t检验。术后6个月更换为甲基丙烯酸树脂材料的永久性中空充填式赝复体。结果13例赝复体均在上颌骨全切除术毕顺利置入，完成即刻修复。患者术后能咀嚼、吞咽和发音，不必鼻饲。术后1、3、6个月戴与不戴赝复体眼球下坠、面部凹陷度和语音清晰度差异均有统计学意义（t值分别为4．67、5．67和16．3B，P值均〈0．05）。问卷调查显示患者对赝复体固位、饮水呛咳及面容的改善均较满意。术后6个月11例患者均顺利更换永久性赝复体，2例患者不要求更换。结论上颌窦癌上颌骨全切除后中空充填式赝复体的精确制作及即刻修复，可提高患者的生活质量。

Objective The feasibility and clinical effects of hollow obturator prosthesis for the repair of maxillofacial defect immediately after maxillectomy for cancer were assessed. Methods Thirteen patients with T3-4aNOM0 maxillary neoplasm were treated by the prostheses immediately after maxilleetomy. According to the 3D-CT reconstruction of nasal sinus, the 3D stereoscopic prototype was constructed before the surgery. Simulating surgery with Surgicare 5.0 software and then the prosthesis 3D stereoscopic model was shaped. The prosthesis was made quickly and precisely with methacrylate resins according to the model and the print mold before surgery, with supplementary tooth at the bottom of prosthesis. In the surgery, the prosthesis was installed instantly after maxillectomy. The patients were followed up at 1, 3 and 6 month after the surgery, respectively. The facial features and the pronunciation clarity were examined and the questionnaires were carried out in the patients, with compareation by paired t-test. The hollow obturator prosthesis would be replaced by permanent prosthesis made of methacrylate resins at 6 month after the surgery. ResultsThe hollow obturator prostheses were installed accurately and maxillofacial defects were repaired immediately after maxillectomy in the 13 patients. Postoperative follow-up showed there were significant differences in eyeball sagging （ t = 4.67, P 〈 0.05 ）, mid-facial region collapse （ t = 5.67, P 〈 0.05） , and pronunciation clarity （ t = 16.38, P 〈 0.05 ） between patients with and without prostheses. Questionnaires showed that all the patients were satisfied with the retention of prostheses, the improvement of appearance, the improvement of the symptom of water choking and speech definition. Six months after the surgery, the hollow obturator prostheses were replaced smoothly by permanent prostheses in 11 of the 13 patients. Conclusion The precise and instant repair of maxillofacial defect by prosthesis after maxillectomy can improve survival quality of patient.