内镜辅助下手术治疗髁突骨软骨瘤临床体会

Endoscope-assisted Vertical Ramus Osteotomy for Condylar Osteochondroma

目的 :利用内镜辅助行下颌支垂直截骨提升术治疗髁突骨软骨瘤,探讨其应用范围及效果。方法 :选择2013-04—2015-05间收治的单侧髁突骨软骨瘤患者,术前进行临床资料采集、咬合关系、面形及影像学检查,对其中无正颌需求或颏点偏斜<3 mm且口内咬合稳定的患者,予以髁突肿物切除术及内镜辅助的下颌支后缘垂直截骨提升术治疗。术后临床检查关节、颌骨、咬合情况,并进行远期影像学随访。结果:共纳入5例患者,采用改良耳颞切口行开放性手术切除髁突顶部肿物,再利用内镜辅助行下颌骨支后缘垂直截骨提升术及坚固内固定,保持原下颌升支高度,其中1例患者附加下颌下缘外形修整术。术后病理提示均为髁突骨软骨瘤。术后5例患者完成随访,其颞下颌关节功能恢复良好,咬合及面型稳定,术后平均28.6个月的CT随访显示无肿瘤复发。结论:在切除髁突骨软骨瘤后,内镜辅助下颌骨升支后缘垂直截骨术,对于咬合轻度偏斜且无法进行正颌手术的髁突骨软骨瘤患者,是一种有效手术方案。该手术设计实现了切除肿物的同时,恢复保留颌骨及咬合关系,同时减小了创伤,是传统手术方案的有力补充。

Objective： To introduce the endoscopic-assisted vertical ramus osteotomy （VRO） for the treatment of condylar osteochondroma and discuss its indications and effectiveness. Methods： 5 cases with unilateral osteochondroma of mandibular condyle but without severe ocelusal deviation were treated with endoscopic-assisted VRO in our department from April 2013 to May 2015. CT imagings were taken for diagnosis and treatment planning. Occlusion, facial contour and maximum mouth opening （MMO） were recorded and compared before and after operation to evaluate the effectiveness of the therapy. Results： 5 patients were treated with endoscopic-assisted VRO and rigid fixation. 1 patients accepted an additional mandibular contour shaping. The pathologic diagnosis were all confirmed as osteochondroma. A mean of 28.6 months follow-up for all 5 cases showed stable post-operative occlusion and facial situation. No functional disturbance were found according to the MMO. Conclusion： For osteochondrama patients without severe malocclusal, endoscopic-assisted VRO is a good option while orthognathic surgery might not be carry out due to patients＂ situation. This operation achieves two targets, tumor resection and occlusion rehabilitation, as well as reduces the trauma. It is a powerful supplement to the traditional surgical procedures.