上颌骨大型缺损个体化三维闭合性功能重建

Closed three-dimensional reconstruction of large maxillary defects with Titanium mesh and auto-ilium and superficial temporal fascia

目的 探索应用外科工作模型预成钛网支架、自体髂骨块游离移植带蒂颊脂垫,颞浅筋膜瓣包裹方式重建上颌骨缺损的方法.方法 采用带蒂颊脂垫瓣衬里,在工作模型上精确预成钛网支架植入,钛钉固定.自体髂骨块植入,微型钛板及植入钛网坚强内固定,颞浅筋膜瓣覆盖钛网、髂骨一期重建上颌骨次全切除4例,全上颌骨切除3例,关闭口鼻腔.结果 7例组织瓣全部成活,面部外形恢复良好,重建了鼻腔、腭部、牙弓的外形.2周后行鼻腔内窥镜检查,发现上颌窦颊脂垫覆盖钛网,粘膜化.颞浅筋膜瓣4～6个月自行完全上皮化.随访8～16个月,进食无食物从鼻腔返流,语音清晰.CT检查证实肿瘤未见复发,张口度3～4.5cm.结论 此方法充分体现个性化三维闭合式上颌骨重建,恢复上颌骨的外形,口腔、语言生理功能令人满意,与其他血管化游离骨复合瓣比较,手术方法简便,皮瓣血运好,易成活,安全系数高,值得推广应用.

Objective To research for the reconstruction of maxillary defects with Titanium mesh brace, auto-ilium, pedicle buccal pad and superficial temporal fascia. Methods A three-dimensional working model was obtained by surgical technique and copied the lost maxillary defects. Then the Titanium mesh braces were placed in the model with pedicle buccal pad inside, fixing with Titanium nails. Auto-ilium bones were implanted, using minor Titanium plate and Titanium mesh for internal fixation. The Titanium mesh was covered with superficial temporal fascia to restore the lost defects. In 7 cases of them, 4 underwent subtotal maxillectomy, 3 with maxillectomy. Results All the tissue flaps in 7 cases were alive, patients had good facial contour. The contour of the nasal cavity, palate and the dental arch were restored. 2 weeks after the reconstruction, the rhinoscopy showed that the Titanium mesh was covered with maxillary buccal pad and mucosalization. Within 4～6 months, the superficial temporal fascia got complete epithelialization. The follow-up of 8～16 months found that no food returned from the nasal cavity, speech cleared. CT proved that tumor free and the mouth could open 3～4.5cm. Conclusion Closed three-dimensional reconstruction of maxillary defects has satisfactory contour, oral and speech function. And it is simpler, safer and easier than other reconstruction with vascularization free bone complex flaps, of which the flaps have good blood circulation and are easy to live. Therefore it is worthwhile for popularization.