赝复体钛网同期植入修复上颌骨切除后眶面部缺损

Prosthetic titanium mesh simultaneous implantation for the treatment of orbital facial defects after maxillectomy

背景:上颌骨创伤或肿瘤切除后可发生面部骨缺损,严重影响患者的外观和生活质量,早期修复对患者意义重大。目的:探讨上颌骨切除后同期钛网与赝复体植入修复眶面部缺损以及长期疗效。方法:选取2009年6月至2013年1月在解放军第四军医大学西京医院耳鼻咽喉头颈外科接受上颌骨切除的患者,治疗中同期植入钛网修复眶底以及上颌窦前壁骨质缺损的上颌窦恶性肿瘤患者共21例,其中上颌骨部分切除4例,上颌骨全切11例,上颌骨扩大切除6例,随访观察钛网在上颌骨切除后遗留的面中部及眶区缺损的修复效果。结果与结论:所有患者同期钛网植入后创口均一期愈合,颜面部轮廓对称,眼球功能正常,患者对颜面部外观基本满意,联合赝复体后能进软食,语言清晰,2例患者在修复后辅助放疗,出现钛网植入体部分外露,经临近皮瓣转移修复后痊愈。结果显示,钛网可以对上颌骨缺损患者进行面部修复重建,对恢复面部形态、防止复视发生、后期功能修复以及提高患者生存质量均有明确疗效。

BACKGROUND: Facial bone defects may occur after maxil ary trauma or tumor resection, which may influence the appearance and the life quality of the patients, so the early repairing has great significance to the patients. OBJECTIVE: To investigate the long-term effect of prosthetic titanium mesh simultaneous implantation for the treatment of orbital facial defect after maxil ectomy. METHODS: Twenty-one maxil ary sinus malignancy patients received maxil ectomy, and the maxil ary sinus malignancy patients treated with titanium mesh simultaneous implantation to repair orbital floor and anterior maxil ary sinus wal bone defects in the Department of Otolaryngology and Head and Neck Surgery, Xijing Hospital, the Fourth Military Medical University of PLA from June 2009 to January 2013 were selected. Among the 21 patients, four cases received partial resection of maxil a, 11 cases received maxil ectomy, and six cases received maxil ary extended resection. The effect of titanium mesh on the repair of midface and orbital defects after maxil ectomy was observed during fol ow-up. RESULTS AND CONCLUSION: Al the patients obtained one stage healing after titanium mesh simultaneous implantation with symmetrical facial contour and normal eyebal function, and the patients were basical y satisfied with the facial appearance. Al the patients could eat soft diet and had clear language after treated with prosthetic titanium mesh implantation; two cases had partial titanium mesh implant exposure after adjuvant radiotherapy, and healed after nearby flap transplantation. The results show that titanium mesh can be used for facial repair and reconstruction in the maxil ary defect patients, and has significant effect in restoring facial appearance, preventing diplopia occurrence, repairing late function and improving life quality.