自体颅骨移植在口腔颌面部畸形中的应用

Autogenous Cranial Bone Grafts for Treating Oral and Maxillofacial Deformity

目的 研究自体颅骨外板移植在治疗口腔颌面部畸形或缺损中的作用。方法 经面中份骨折复位固定时的冠状切口或颅骨直接切口 ,获取所需的颅骨外板 ,经调磨塑形后配合坚强内固定技术用于口腔颌面部畸形的矫正或骨骼支架的重建。结果 3 1例口腔颌面部畸形或骨缺损患者用自体颅骨进行治疗。其中外伤所致眶底缺损 17例、颧骨陈旧性骨折 6例、颞颌关节强直面部畸形 5例 ,肿瘤切除后重建 2例 ,唇腭裂畸形 1例。通过 6个月至 7年 (平均 11个月 )的随访 ,所有病例术后创口愈合良好 ,移植骨成活 ,未见明显吸收。供受骨区切口瘢痕不明显 ,患者面部外形均有不同程度的改进 ,取得了满意的临床效果。 1例术后 3个月内有轻微下睑外翻 ,通过自行按摩半年后已不明显。结论 自体颅骨移植并发症少 ,移植后很少吸收 ,可很好的完成面部支架的重建 ,有效地矫正各种原因导致的口腔颌面部骨骼畸形及缺损 ,颅骨采取方便 ,手术创伤小 ,对生理功能干扰小 ,是理想的移植材料。

Objective To evaluate the effect of the autogenous split-thickness cranial bone grafts on treatment of deformity of oral and maxillofacial regions. Methods The split-thickness cranial bone was harvested through the coronal incisions or the parietotemporal region incisions. The bone graft was then fashioned to the appropriate size and configuration and fixed to the regions of defects and deformities. The cranial bone was used to reconstruct facial bone framework or as sustaining bone graft for facial augmentation. Results 31 patients with the oral and maxillofacial deformities or bone defects were repaired with the cranial bone grafts, including 17 cases of orbital floor defects, 6 cases of malunion of the zygoma fractures, 5 cases of secondary deformity after ankylosis of temporomandibular joint, 2 cases of bone reconstruction after tumor resection and 1 case of cleft palate deformity. The followed-up period ranged from 6 months to 7 years, averaging 11 months. There were no complications of infection and extrusion, no obvious bone resorption was observed, and the facial appearance were greatly improved. Only one patient had a small ectropion which persisted three months. After six-month, the ectropion was not obvious. Conclusion Autogenous bone grafts used to reconstruct the defect and deformity of oral and maxillofacial regions can reduce the risks of infection and extrusion, and there is less visible scar and less bone resorption. Skull bone is an ideal source of bone graft material in the oral and maxillofacial deformity.