钛网与前臂游离皮瓣闭合式三维重建上颌骨缺损  

Closed and three-dimensional reconstruction of maxillary defects with titanium mesh and free forearm flap

作　　者：孙坚[1] 李军[1] 张志愿[1] 叶为民[1] 何悦[1] 

机构地区：[1]上海第二医科大学附属第九人民医院口腔颌面外科,200011

出　　处：《实用口腔医学杂志》2002年第4期291-293,共3页Journal of Practical Stomatology

摘　　要：目的 :探讨应用钛网与前臂皮瓣对上颌骨缺损行闭合式三维重建方法的可行性。方法 :自 2 0 0 0 0 3起 ,我们对 10例上颌骨因肿瘤及外伤后缺损的病例 ,分别行上颌骨次全切除 7例 ,全上颌切除 3例 ,其中Ⅱ类缺损 7例 ,Ⅲ类缺损 3例。同期采用钛网支架对上颌骨各壁进行构筑 ,恢复其外形 ;并对暴露在口腔或鼻腔内的创面用前臂桡侧游离皮瓣行闭合式修复。结果 :10例上颌骨缺损的病例经 3～ 18个月随访观察 ,术后皮瓣全部成活 ,其中 3例上颌全切的病例 ,采用了前臂游离皮瓣折叠修复。恢复了鼻腔、腭部、上颌牙槽及牙弓的外形。经CT检查证实 ,肿瘤未见复发。张口度 2 .5～ 4cm ,进食时无食物从鼻腔返流 ,语言较为清晰 ,其中 3例钛网支架构筑的外形已行可摘局部义齿修复 ,能进普食。 2例上颌骨全切的病例修复术后 6～ 12个月 ,经鼻咽内窥镜检查 ,可喜地发现钛网内衬有正常软组织覆盖。结论 :应用钛网支架构筑上颌骨缺损的外形 ,其上覆盖前臂桡侧游离皮瓣 ,此种闭合式三维重建上颌骨缺损的方法 ,经临床证实 ,术后基本恢复了上颌骨的外形和功能。该手术简便可行 。Objective: To study the feasibility of closed and three-dimensional reconstruction of maxillary defects with titanium mesh and free forearm flap. Methods: Maxillary defects, 3 of type Ⅱ and 7 of type Ⅲ, due to tumor or trauma were closely reconstructed with titanium mesh to restore the profile of maxilla and with radial flap to close the oral and the nasal wound surfaces following total maxillectomy (in 3 cases) and subtotal maxillectomy(in 7 cases). Results: 10 cases were followed up for 3～18 months. All the flaps were alive. The maxilla nasal and oral cavity were restored in all the cases and denture was applied in 3 cases. No neoplasm were fond by CT. Mouth opening was 2.5～4.0cm. Epithelium on the surface of the titanium mesh was found by nasopharyngoscope in 2 cases. Conclusion: The closed and three-dimensional reconstruction of maxillary defect with titanium mesh and free forearm flap can restore the shape and the function of maxilla.

关 键 词：钛网 前臂游离皮瓣 闭合式三维重建 上颌骨缺损 颌面部肿瘤 

分 类 号：R782.25[医药卫生—口腔医学]