山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (5): 113-117.doi: 10.6040/j.issn.1673-3770.0.2020.326

• • 上一篇    下一篇

上颌骨切除术后外科修复进展

李亚楠1,皇甫辉2   

  1. 1. 山西医科大学第一临床医学院, 山西 太原 030000;
    2. 山西医科大学第一医院 耳鼻咽喉头颈外科, 山西 太原 030000
  • 发布日期:2021-09-29
  • 通讯作者: 皇甫辉. E-mail:13934518228@163.com

Advancements in surgical repair after maxillectomy

LI Yanan1,HUANGFU Hui2   

  1. 1. Department of Clinical Medicine, the First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China;
    2. Department of Otolaryngology Head & Neck Surgery, the First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China
  • Published:2021-09-29

摘要: 外伤、先天性畸形等原因会造成上颌骨缺损,但绝大多数上颌骨缺损发生在恶性肿瘤切除术后。术后造成关键解剖结构的缺损,不仅严重损害患者外形美观,而且造成吞咽、言语、咀嚼等功能缺失,使患者遭受身心创伤。因此,上颌骨因解剖复杂性使得修复重建手术成为外科医生面临的最困难的挑战之一。但上颌骨缺损尚未有统一的分类系统和对应的修复方法。此篇综述回顾总结上颌骨缺损分类、修复类型及优缺点、修复方法等,并对上颌骨缺损分类的未来进行展望。

关键词: 分类, 上颌骨缺损, 赝复体, 自体组织, 修复方法

Abstract: Maxillary defects can result from trauma, congenital malformation and other causes, but are mostly caused after malignant tumor resection. Postoperative defects of key anatomical structures severely damage the patient's esthetic appearance and cause the loss of swallowing, pronunciation, chewing and others functions, leading to physical and mental trauma. Therefore, the anatomical complexity of the maxilla makes reconstruction surgery one of the most difficult challenge for surgeons. However, there is no unified classification system or corresponding method for maxillary defect repair. This review is aimed at summarizing the classification system for maxillary defects, repair types, advantages and disadvantages, repair methods and future prospects of maxillary defect classification.

Key words: Classification, Maxillary defect, Prosthesis, Autologous tissue, Repair method

中图分类号: 

  • R782.2
[1] Breeze J, Rennie A, Morrison A, et al. Health-related quality of life after maxillectomy: obturator rehabilitation compared with flap reconstruction[J]. Br J Oral Maxillofac Surg, 2016, 54(8): 857-862. doi:10.1016/j.bjoms.2016.05.024.
[2] Hassanein AG. Continuous validity of temporalis muscle flap in reconstruction of postablative palatomaxillary defects[J]. J Craniofac Surg, 2017, 28(2): e130-e137. doi:10.1097/SCS.0000000000003323.
[3] Low TH, Lindsay A, Clark J, et al. Reconstruction of maxillary defect with musculo-adipose rectus free flap[J]. Microsurgery, 2017, 37(2): 137-141. doi:10.1002/micr.22439.
[4] Brignardello-Petersen R. Insufficient evidence about quality of life in patients undergoing surgical or prosthetic rehabilitation after maxillectomy owing to limitations in systematic review process and evidence about this question[J]. J Am Dent Assoc, 2018, 149(10): e138. doi:10.1016/j.adaj.2018.03.017.
[5] Alam D, Ali Y, Klem C, et al. The evolution of complex microsurgical midface reconstruction: a classification scheme and reconstructive algorithm[J]. Facial Plast Surg Clin North Am, 2016, 24(4): 593-603. doi:10.1016/j.fsc.2016.06.012.
[6] Cordeiro PG, Chen CM. A 15-year review of midface reconstruction after total and subtotal maxillectomy: part I. Algorithm and outcomes[J]. Plast Reconstr Surg, 2012, 129(1): 124-136. doi:10.1097/prs.0b013e318221dca4.
[7] Brown JS, Rogers SN, McNally DN, et al. A modified classification for the maxillectomy defect[J]. Head Neck, 2000, 22(1): 17-26. doi:10.1002/(sici)1097-0347(200001)22:1<17::aid-hed4>3.0.co;2-2.
[8] Brown JS, Shaw RJ. Reconstruction of the maxilla and midface: introducing a new classification[J]. Lancet Oncol, 2010, 11(10): 1001-1008. doi:10.1016/S1470-2045(10)70113-3.
[9] Cannady SB, Rosenthal EL, Knott PD, et al. Free tissue transfer for head and neck reconstruction: a contemporary review[J]. JAMA Facial Plast Surg, 2014, 16(5): 367-373. doi:10.1001/jamafacial.2014.323.
[10] 廖晓燕, 李庆艳, 陈皓华, 等. 恶性肿瘤术后上颌骨单侧缺损的赝复体修复[J]. 口腔颌面修复学杂志, 2018, 19(1): 14-18. doi:10.3969/j.issn.1009-3761.2018.01.005. LIAO Xiaoyan, LI Qingyan, CHEN Haohua, et al. Prostheses for unilateral maxillary defects after malignant tumor surgery[J]. Chinese Journal of Prosthodontics, 2018, 19(1): 14-18. doi:10.3969/j.issn.1009-3761.2018.01.005.
[11] Yetzer J, Fernandes R. Reconstruction of orbitomaxillary defects[J]. J Oral Maxillofac Surg, 2013, 71(2): 398-409. doi:10.1016/j.joms.2012.04.035.
[12] Vincent A, Burkes J, Williams F, et al. Free flap reconstruction of the maxilla[J]. Seminars in Plastic Surgery, 2019, 33(1): 30-37. doi:10.1055/s-0039-1677701.
[13] 于森, 王洋, 毛驰, 等. 1107例上颌骨缺损的临床分类及修复方法分析[J]. 北京大学学报(医学版), 2015, 47(3): 509-513. doi:10.3969/j.issn.1671-167X.2015.03.026. YU Sen, WANG Yang, MAO Chi, et al. Classification and reconstruction of 1 107 cases of maxillary defects[J]. Journal of Peking University(Health Sciences), 2015, 47(3): 509-513. doi:10.3969/j.issn.1671-167X.2015.03.026.
[14] 葛玉珍. 游离皮瓣在修复口腔颌面部缺损中的临床应用价值[J]. 中国医疗美容, 2016, 6(9): 25-27. doi:10.19593/j.issn.2095-0721.2016.09.013.
[15] Wilkman T, Husso A, Lassus P. Clinical comparison of scapular, fibular, and iliac crest osseal free flaps in maxillofacial reconstructions[J]. Scand J Surg, 2019, 108(1): 76-82. doi:10.1177/1457496918772365.
[16] Ni YK, Lu P, Yang Z, et al. The application of fibular free flap with flexor hallucis longus in maxilla or mandible extensive defect: a comparison study with conventional flap[J]. World J Surg Oncol, 2018, 16(1): 149. doi:10.1186/s12957-018-1450-2.
[17] Joseph ST, Thankappan K, Buggaveeti R, et al. Challenges in the reconstruction of bilateral maxillectomy defects[J]. J Oral Maxillofac Surg, 2015, 73(2): 349-356. doi:10.1016/j.joms.2014.08.036.
[18] di Carlo S, Valentini V, Grasso E, et al. Implant-supported rehabilitation using GBR combined with bone graft on a reconstructed maxilla with the Fibula free flap[J]. Case Reports in Dentistry, 2019, 2019: 2713542. doi:10.1155/2019/2713542.
[19] Taylor GI, Corlett RJ, Ashton MW. The evolution of free vascularized bone transfer: a 40-year experience[J]. Plast Reconstr Surg, 2016, 137(4): 1292-1305. doi:10.1097/PRS.0000000000002040.
[20] Grinsell D, Catto-Smith HE. Modifications of the deep circumflex iliac artery free flap for reconstruction of the maxilla[J]. J Plast Reconstr Aesthet Surg, 2015, 68(8): 1044-1053. doi:10.1016/j.bjps.2015.04.028.
[21] Jeremiah CT, Bryan B, Samip NP. Scapular Tip Free Flap for Head and Neck Reconstruction[J].Otolaryngol Head Neck Surg,2019,160(1):57-62.doi: 10.1177/0194599818791783.
[22] Tarsitano A, Battaglia S, Ciocca L, et al. Surgical reconstruction of maxillary defects using a computer-assisted design/computer-assisted manufacturing-produced titanium mesh supporting a free flap[J]. J Craniomaxillofac Surg, 2016, 44(9): 1320-1326. doi:10.1016/j.jcms.2016.07.013.
[23] 吴昆旻, 吴建, 李泽卿, 等. 3D打印辅助上颌骨切除术后缺损重建[J]. 山东大学耳鼻喉眼学报, 2016, 30(6): 29-32, 36. doi:10.6040/j.issn.1673-3770.0.2016.368. WU Kunmin, WU Jian, LI Zeqing, et al. Application of three-dimensional printing technique in assisting reconstruction after maxillectomy[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(6): 29-32, 36. doi:10.6040/j.issn.1673-3770.0.2016.368.
[24] Aksu AE, Uzun H, Bitik O, et al. Microvascular tissue transfers for midfacial and anterior cranial base reconstruction[J]. J Craniofac Surg, 2017, 28(3): 659-663. doi:10.1097/SCS.0000000000003448.
[25] Chang EI, Hanasono MM. State-of-the-art reconstruction of midface and facial deformities[J]. J Surg Oncol, 2016, 113(8): 962-970. doi:10.1002/jso.24150.
[26] Eskander A, Kang SY, Teknos TN, et al. Advances in midface reconstruction: beyond the reconstructive ladder[J]. Curr Opin Otolaryngol Head Neck Surg, 2017, 25(5): 422-430. doi:10.1097/MOO.0000000000000396.
[27] Chanowski EJ, Casper KA, Eisbruch A, et al. Restoration of the orbital aesthetic subunit with the thoracodorsal artery system of flaps in patients undergoing radiation therapy[J]. Journal of Neurological Surgery. Part B, Skull Base, 2013, 74(5): 279-285. doi:10.1055/s-0033-1347366.
[28] Fujioka M, Hayashida K, Murakami C. Vascularized bone graft is a better option for the reconstruction of maxillary defects[J]. Eur Arch Otorhinolaryngol, 2013, 270(10): 2779-2781. doi:10.1007/s00405-013-2619-5.
[29] Fu K, Liu YM, Gao N, et al. Reconstruction of maxillary and orbital floor defect with free Fibula flap and whole individualized titanium mesh assisted by computer techniques[J]. J Oral Maxillofac Surg, 2017, 75(8): 1791.e1-1791791.e9. doi:10.1016/j.joms.2017.03.054.
[30] Lenox ND, Kim DD. Maxillary reconstruction[J]. Oral Maxillofac Surg Clin North Am, 2013, 25(2): 215-222. doi:10.1016/j.coms.2013.01.004.
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