同期神经化腓骨瓣用于下颌骨重建及下唇感觉恢复的术式初探

A primary study on application of neuralized fibula flap for mandibular reconstruction and sensory restoration of the lower lip

目的:探讨下颌骨及下牙槽神经因肿瘤截除后,同期颌骨重建及感觉恢复的新方法,为临床提供参考。方法:对1例下颌骨成釉细胞瘤患者行下颌骨节段性切除,术中一并切除与病灶密切的下牙槽神经,同期行神经化血管化腓骨游离皮瓣移植修复。术后通过影像学观察其移植骨吸收情况,应用两点辨别觉和感觉测试丝评估感觉保存效果。结果:术后随访9个月,患者颜面自然对称,皮瓣存活良好,移植骨稳定未见明显吸收,下唇感觉功能良好,颏部稍次,无咬唇、流涎等问题;受区及供区未见并发症。结论:同期重建神经的新方法对腓骨瓣移植重建下颌骨时恢复下唇感觉及预防移植骨术后吸收具有较好效果。

PURPOSE:To explore a new method of simultaneous jaw reconstruction and sensory recovery after resection of the mandible and inferior alveolar nerve due to tumor,so as to provide reference for clinical practice.METHODS:Segmental resection of mandibular bone was performed in a patient with mandibular ameloblastoma.The inferior alveolar nerve closely associated with the lesion was removed during the operation,neurovascularized fibula free flap was transplanted at the same time.The graft resorption was observed by postoperative imaging,and sensory preservation was evaluated by applying two-point discriminative sensation and touch test using sensory test wire.RESULTS:At the 9-month postoperative follow-up,the patient exhibited a naturally symmetrical facial appearance,with the flap displaying excellent survival and blood supply.The grafted bone remained stable without noticeable resorption,and the lower lip regained good sensory function while sensory function was partially restored to the chin.There were no issues such as lip-biting or salivation.Furthermore,neither recipient nor donor areas exhibited adverse complications.CONCLUSIONS:This innovative approach of simultaneous nerve reconstruction demonstrates promising efficacy in restoring lower lip sensation and preventing postoperative grafted bone resorption in fibula flap transplantation for mandibular reconstruction.