【摘要】：目的探討采用口內(nèi)入路切除下頜骨良性腫瘤同期自體骨移植修復(fù)重建術(shù)的臨床療效。方法 2009年1月-2012年9月,收治15例下頜骨良性腫瘤患者。其中男7例,女8例;年齡18~45歲,平均30歲。病理診斷為成釉細(xì)胞瘤11例,牙源性角化囊腫3例,黏液瘤1例。病變?nèi)睋p部位按Urken’s CRBS分類:下頜骨同側(cè)體部(B型)3例,升支(R型)3例,體部+升支(BR型)9例。手術(shù)均采用口內(nèi)入路(1例因病變部位至乙狀切跡平面,在耳前行輔助切口)。分別采用以計(jì)算機(jī)輔助設(shè)計(jì)/計(jì)算機(jī)輔助制造技術(shù)構(gòu)建的下頜骨模型上彎制重建鈦板(9例)或術(shù)中直接按頜骨形狀彎制重建鈦板(6例)。切除下頜骨腫瘤后將彎制重建鈦板原位固定,根據(jù)骨缺損情況分別采用自體髂骨(11例)或血管化腓骨瓣(4例)移植修復(fù)。6例保留下齒槽神經(jīng)。結(jié)果術(shù)后14例切口Ⅰ期愈合;1例發(fā)生植骨區(qū)感染,經(jīng)相應(yīng)處理后Ⅱ期愈合。15例均獲隨訪,隨訪時(shí)間1~4年,平均2.5年。末次隨訪時(shí),患者功能均恢復(fù)良好,無(wú)面神經(jīng)損傷表現(xiàn),余留牙列咬合關(guān)系基本維持術(shù)前狀態(tài);咀嚼功能滿意;開口度30~35 mm,平均33 mm;吞咽及語(yǔ)言功能正常。口外僅有輔助切口及穿頰器輕微瘢痕,患者對(duì)面部外形滿意。6例保留下齒槽神經(jīng)患者術(shù)后下唇麻木癥狀緩解。隨訪期間均無(wú)復(fù)發(fā)。結(jié)論經(jīng)口內(nèi)入路切除下頜骨良性腫瘤同期行自體骨植骨修復(fù)重建術(shù)后面部無(wú)明顯瘢痕,幾乎不損傷面神經(jīng),外形恢復(fù)良好,是可靠的美容性手術(shù)入路和手術(shù)重建方案。
[Abstract]:Objective to investigate the clinical effect of intraoral resection of benign mandibular tumors with autogenous bone graft. Methods from January 2009 to September 2012, 15 patients with benign mandibular tumors were treated. There were 7 males and 8 females with an average age of 30 years (1845 years). There were 11 cases of ameloblastoma, 3 cases of odontogenic keratocyst and 1 case of myxoma. According to Urken's CRBS classification, there were 3 cases of ipsilateral body (type B), 3 cases of ascending branch (R type) and 9 cases of ascending branch of body (BR type). Intraoral approach was used in all cases (1 case was assisted incision before ear operation due to lesion site to sigmoid notch plane). The mandibular model was constructed by computer aided design (CAD) / computer-aided manufacturing (CAD / CAM). The mandibular model was reconstructed with titanium plate (9 cases) or the titanium plate was bent directly according to the shape of mandible (6 cases). After the mandibular tumor was resected, titanium plate was fixed in situ, and autogenous iliac bone (n = 11) or vascularized fibula flap (n = 4) were used to repair the bone defect, and the inferior alveolar nerve was preserved in 6 cases. Results there were 14 cases of primary wound healing, 1 case of infection of bone graft area, and 15 cases of second stage healing after corresponding treatment. The follow-up time was 1 ~ 4 years with an average of 2.5 years. At the last follow-up, all the patients recovered well, no facial nerve injury appeared, the occlusion relationship of residual dentition was basically in the preoperative state, the masticatory function was satisfactory, the opening degree was 30 ~ 35 mm, the average swallowing was 33 mm; and the speech function was normal. The patients were satisfied with facial appearance. 6 patients with inferior alveolar nerve were relieved of lower lip numbness after operation. No recurrence occurred during follow-up. Conclusion Transoral resection of benign mandibular tumors with autogenous bone graft at the same time has no obvious scar, almost no injury to facial nerve, and good shape recovery. It is a reliable cosmetic approach and reconstruction plan.
【作者單位】： 浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院口腔科;浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院腫瘤科;
【基金】：浙江省衛(wèi)生廳基金資助項(xiàng)目(N20110323)~~
【分類號(hào)】：R739.82

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