复合髂骨肌皮瓣同期颧种植重建上颌骨缺损一例

COMBINED VASCULARIZED ILIAC OSTEOMUSCULOCUTANEOUS FLAP WITH ZYGOMATIC IMPLANT ANCHORAGE IN RECONSTRUCTING 1 CASE OF MAXILLARY DEFECT

目的应用复合髂骨肌皮瓣同期植入颧种植体和普通种植体行单侧上颌骨缺损的功能重建。方法2003年8月,B row nⅡ类的单侧上颌骨缺损面部凹陷畸形患者1例,术前三维CT检查,制作快速原型,在快速原型上设计重建方案,行模板外科操作,手术以髂骨肌瓣复合腹壁外侧皮瓣重建上颌骨,术中同期植入1枚B ra。nem ark颧种植体和2枚普通种植体,术后6个月二期手术行种植体支持固定义齿修复。结果血管化骨瓣及皮瓣移植均获成功,术后6个月种植体与移植骨骨性结合。面部外形双侧对称,腭部形态恢复良好,患侧咬牙合关系恢复正常,咀嚼牙合力达健侧的76.3%,临床效果满意。术后随访14个月,肿瘤未复发,种植体周围未见骨质吸收。结论复合髂骨肌皮瓣结合同期颧种植体植入可作为上颌骨缺损个体化功能重建的可靠方法之一。

Objective To reconstruct the maxillary defect by using free vascularized iliac osteomusculocutaneous flap combined with immediate zygomatic implantation for early rehabilitation of maxillary contour and masticatory function. Methods in August 2003, the patient presented with deformity of left middle face （Brown Ⅱ type defect） after subtotal maxillectomy. After hospitalization, a set of preoperative preparations were made, including spiral CT scanning, manufacture of nature size anatomical model and implantation protocol design. The maxillary defect was reconstructed with free vascularized iliac osteomusculocutaneous flap combined with simultaneous insertion of one Branemark zygomatic implant and two general implants. Six months later the prosthesis were placed. Results The vascularized osteomusculocutaneous flap survived, the osseointegration was observed between bone and implant 6 months later. The contour of face and palate was satisfactory, the normal occluding relation was gained. The average masticatory force of operative side was 76.3% of the normal side. No tumor recurrence was noticed during the follow up of 14 months. Conclusion It is a reliable method for functional reconstruction of maxillary defect via vascularized iliac osteomusculocutaneous flap combined with immediate zygomatic implantation.