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目的探讨咬合导板及颌间牵引钉技术在游离腓骨瓣修复下颌骨缺损中的应用价值。方法 2011年8月-12月,收治7例下颌骨肿瘤患者。男4例,女3例;年龄32～65岁,中位年龄50岁。下颌骨成釉细胞瘤5例,牙龈癌2例。术前制备咬合导板并确定颌间牵引钉植入位置;术中5例行下颌骨半侧切除、2例行保留髁突的下颌骨半侧切除后,切取长11～13 cm的腓骨瓣修复下颌骨缺损,腓骨瓣固定时采用咬合导板和颌间牵引钉技术恢复咬合关系。供区直接拉拢缝合。结果手术时间7～12 h,平均9.5 h。术后腓骨瓣均成活,供、受区切口均Ⅰ期愈合。患者均获随访,随访时间10～14个月,平均12.3个月。患者面部对称,咬合关系良好,张口度及下颌侧向运动正常,双侧颞下颌关节区无疼痛等不适。全口曲面体层片显示下颌骨缺损区域重建形态及固位良好。随访期间肿瘤无复发。结论游离腓骨瓣移植修复下颌骨缺损术中应用咬合导板和颌间牵引钉技术,能简化手术操作,精确恢复患者面部外形和咬合关系,提高术后口腔舒适性。
Objective To investigate the value of the technique of bite guide and intermaxillary traction nail in repairing mandibular defects with free fibular flap. Methods From August 2011 to December 2011, 7 patients with mandibular tumors were treated. 4 males and 3 females; aged 32 to 65 years old, the median age of 50 years. 5 cases of mandibular ameloblastoma, 2 cases of gingival cancer. Preoperative preparation of bite guide plate and determine the position of intermaxillary traction nail implantation; 5 cases of mandibular resection, 2 cases of condylar mandibular half resection, cut length of 11 ~ 13 cm fibular flap repair Mandibular defect, fibular flap fixation using occlusal guide plate and intermaxillary traction nail technology to restore occlusal relationship. For the area directly draw suture. Results The operation time was 7-12 h with an average of 9.5 h. Postoperative fibula flap were alive, for the district cut by the first phase of healing. Patients were followed up for 10 to 14 months with an average of 12.3 months. Patients face symmetry, good occlusion, mouth opening and normal lateral mandibular movement, bilateral temporomandibular joint area without pain and other discomfort. Full-mouth surface tomography showed reconstruction of mandibular defect area and good shape retention. No recurrence of tumor during follow-up. Conclusion The treatment of mandibular defect with free fibula flap transplantation can reduce the surgical operation and accurately restore the facial shape and occlusal relationship and improve the postoperative oral comfort by using the technique of occlusal guide plate and intermaxillary traction nail.