颌面缺损修复效果欠佳的有关医源性因素讨论(二)  

Discussion on iatrogenic factors of inferior maxillofacial defect restoration results(Ⅱ)

作　　者：冯志宏 谢瑞 刘欢[2] 王婉蓉 赵铱民 FENG Zhihong;XIE Rui;LIU Huan;WANG Wanrong;ZHAO Yimin(State Key Laboratory of Military Stomatology&National Clinical Research Center for Oral Diseases&Shaanxi Key Laboratory of Stomatology,Department of Prosthodontics,The Third Affiliated Hospital of Air Force Medical University,China,Xi'an 710032;Xinqiao Hospital of the Third Military Medical University,Chongqing)

机构地区：[1]军事口腔医学国家重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔医学重点实验室,空军军医大学第三附属医院修复科,西安710032 [2]第三军医大学新桥医院

出　　处：《实用口腔医学杂志》2022年第4期421-426,共6页Journal of Practical Stomatology

基　　金：空军军医大学第三附属医院科技发展基金(编号:2020JZ016-01);空军军医大学第三附属医院新技术业务面上项目(编号:2020.12-2022.12)。

摘　　要：通过整理2015~2019年在第四军医大学口腔医院修复科赝复诊室接诊的部分涉及上颌骨、下颌骨及软腭缺损、且赝复体修复效果欠佳的颌面缺损病例,根据前期手术治疗及赝复体修复效果进行分析,探讨导致赝复体修复效果欠佳的有关医源性因素。将所述病例分为四类,第一类:上颌骨切除术后,未及时、正确地进行张口训练,导致张口受限而无法进行良好的口内治疗;第二类:上颌骨切除术中,前庭沟切口及颊部创口未通过中厚或全厚植皮覆盖,导致上唇挛缩塌陷,导致赝复体修复后面容欠佳;第三类:软腭缺损较大,仅余留少量软腭组织,既无功能还影响软腭赝复体伸入缺损腔;第四类:下颌牙槽骨部分缺损,余留牙槽骨覆盖非角化黏膜,导致常规赝复体压痛明显,且不利于种植修复。通过病例分析,总结得出能够提高赝复体修复效果的建议。期望外科医师在手术切除肿瘤的同时,尽可能地为后期赝复体修复创造更佳的条件,提高该类患者的最终赝复体修复效果,提高其生存及生活质量。The data of the patients with the defect in maxilla,mandible and soft palate underwent surgical and prosthesis treatment from 2015 to 2019 were collected.The iatrogenic factors leading to poor repair effect were analyzed.The cases with poor restoration effect were divided into 4 types.The first type:maxillary defect without timely and correctly oral opening training after surgical operation,resulting in limited oral opening and the difficulty of treatment in oral cavity.The second type:maxillary defect after surgiry without the corver of medium or full thickness mucosa or skin graft on vestibular groove incision and buccal wound resulting in the contracture and collapse of the upper lip with poor facial appearance after prosthesis restoration.The third type:the soft palate defect after surgery with only a small amount of soft palate tissue remaining and without function reulting in the difficulty of placement of the soft palate prosthesis into the defect cavity.The fourth type:partial defect of mandibular alveolar bone with remaining alveolar bone covering of non-keratinized mucosa,resulting in obvious tenderness for conventional prosthesis and difficulty for implantation.Through case analysis,some suggestions for the improvement of the prosthesis restoration were summarized.It is expected that maxillofacial surgeons try their best to create better conditions for the later prosthesis restoration,and improve the life quality of the patients after tumor removal.

关 键 词：赝复体 颌面缺损 张口受限 软腭缺损 

分 类 号：R783.9[医药卫生—口腔医学]