数字化赝复体术中修复Brown Ⅱ类缺损后的功能评价
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摘要
目的探讨数字化赝复体术中修复BrownⅡ类缺损后的功能及面容恢复程度。方法 2016年8月至2017年8月收治10例因肿瘤致BrownⅡ类缺损患者;对其行术中赝复体修复。术后1、3、6个月分析语音清晰度、吞咽功能、咀嚼功能、面容对称性。结果赝复体修复后1、3、6个月语音清晰度显著提高(P=0.004、0.015、0.001,P<0.05);吞咽功能提高1～2级,有效率25%(2/8),显效率75%(6/8);口角偏斜角度、双侧唇部高度差、最大偏差距离、变化区域体积显著减小(P=0.007、0.044、0.039,0.042,P<0.05);患侧牙合力比值(20.45±2.55)%,健侧牙合力比值(79.55±2.55)%,牙合力不对称指数(59.10±5.09)%,患侧牙合力恢复指数范围(25.82±4.04)%。结论数字化赝复体术中修复BrownⅡ类缺损可获得良好的面容及功能恢复。
Objective To assess function and facial appearance after instant rehabilitation of BrownⅡmaxilla defect with digital prosthesis. Methods Due to tumor resection, 10 patients with Brown Ⅱ maxilla defect were treated with prosthesis from August, 2016 to August, 2017 in operation. The speech intelligibility, swallowing function, masticatory function and facial symmetry were evaluated 1 month, 3 months and 6 months after operation. Results Speech intelligibility was improved significantly via prosthesis rehabilitation 1 month, 3 months and 6 months after operation(P=0.004, 0.015, 0.001, P<0.05). The effective rate and apparent rate of swallowing were respectively 25%(2/8) and 75%(6/8). The skewed degree of mouth corner, the difference of bilateral lip height, the maximum deviation distance and the change area volume decreased significantly(P=0.007, 0.044, 0.039, 0.042, P<0.05). The ratios of biting force were(20.45±2.55)% and(79.55±2.55)% in affected and normal sides. Asymmetric index of biting force was(59.10±5.09)%. Biting force in affected side was recovered to(25.82±4.04)%. Conclusion Digital prosthesis can repair Brown maxillaⅡdefect in surgery with excellent rehabilitation of facial appearance and function.
Objective To assess function and facial appearance after instant rehabilitation of BrownⅡmaxilla defect with digital prosthesis. Methods Due to tumor resection, 10 patients with Brown Ⅱ maxilla defect were treated with prosthesis from August, 2016 to August, 2017 in operation. The speech intelligibility, swallowing function, masticatory function and facial symmetry were evaluated 1 month, 3 months and 6 months after operation. Results Speech intelligibility was improved significantly via prosthesis rehabilitation 1 month, 3 months and 6 months after operation(P=0.004, 0.015, 0.001, P<0.05). The effective rate and apparent rate of swallowing were respectively 25%(2/8) and 75%(6/8). The skewed degree of mouth corner, the difference of bilateral lip height, the maximum deviation distance and the change area volume decreased significantly(P=0.007, 0.044, 0.039, 0.042, P<0.05). The ratios of biting force were(20.45±2.55)% and(79.55±2.55)% in affected and normal sides. Asymmetric index of biting force was(59.10±5.09)%. Biting force in affected side was recovered to(25.82±4.04)%. Conclusion Digital prosthesis can repair Brown maxillaⅡdefect in surgery with excellent rehabilitation of facial appearance and function.
引文
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[5] 王丽萍.吞咽障碍的诊断与评价[J].听力学及言语医学疾病,2008,16(4):275-278.
[6] Chan RC,Wei FC,Wong JK,et al.Is distal fibular fracture an absolute contraindication to free fibular flap harvesting?a review of evidence in the literature and illustration by a successful case[J].Microsurgery,2015,35(1):60-63.
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[8] Kar S,Tripathi A.Treatment outcome with delayed maxillary obturator prosthesis:case series of four patients[J].J Prosthodont,2016,25(2):174-177.
[9] Sinha D,Banerjee S,Chowdhury S.Fabrication of an immediate surgical obturator for a patient with resection of the maxillary antrum and bony orbital floor[J].J Prosthet Dent,2014,112(2):376-378.
[10] Zhang WB,Wang Y,Liu XJ,et al.Reconstruction of maxillary defects with free fibula flap assisted by computer techniques[J].J Craniomaxillofac Surg,2015,43(5):630-636.
[11] K??ri?inen M,Kuuskeri M,Gremoutis G,et al.Utilization ofthree-dimensional computer-Aided preoperative virtual planning and manufacturing in maxillary and mandibular reconstruction with a microvascular fibula flap[J].J Reconstr Microsurg,2016,32(2):137-141.
[12] Li P,Xuan M,Liao C,et al.Application of intraoperative navigation for the reconstruction of mandibular defects with microvascular fibular flaps-preliminary clinical experiences[J].J Craniofac Surg,2016,27(3):751-755.
[13] Lenox ND,Kim DD.Maxillary reconstruction[J].Oral Maxillafac Surg Clim North Am,2013,25(2):215-222.
[14] 徐君伍.口腔修复理论与临床[M].北京:人民卫生出版社,1999 :88-93.
[15] Berssenbrügge P,Berlin NF,Kebeck G,et al.2D and 3D analysis methods of facial asymmetry in comparison[J].J Craniomaxillofac Surg,2014,42(6):e327-334.
[16] Kook MS,Jung S,Park HJ,et al.A comparison study of different facial soft tissue analysis methods[J].J Craniomaxillofac Surg,2014,42(5):648-656.
[17] Zhao YJ,Xiong YX,Wang Y.Three-dimensional accuracy of facial scan for facial deformities in clinics:a new evaluation method for facial scanner accuracy[J].PLoS One,2017,12(1):e0169402.
[18] Chen C,Ren W,Gao L,et al.Function of obturator prosthesis after maxillectomy and prosthetic obturator rehabilitation[J].Braz J Otorhinolaryngol,2016,82(2):177-183.
[19] Noh K,Pae A,Lee JW,et al.Fabricating a tooth-and implant-supported maxillary obturator for a patient after maxillectomy with computer-guided surgery and CAD/CAM technology:a clinical report[J].J Prosthet Dent,2016,115(5):637-642.
[20] Roy AA,Efanov JI,Mercier-Couture G,et al.Zygomatico-maxillary reconstruction with computer-aided manufacturing of a free DCIA osseous flap and intraoral anastomoses[J].Plast Reconstr Surg Glob Open,2017,5(2):e1226.
[2] 王洋,王育新,张诗雷,等.3D打印赝复体即刻修复Brown Ⅱ类缺损的临床初步研究[J].中华整形外科杂志,2018,34(3):246-251.
[3] Brown JS,Rogers SN,Mcnally DN,et al.A modified classifica-tion for the maxillectomy defect[J].Head Neck,2000,22(1):17-26.
[4] 王国民,朱川,袁文化,等.汉语语音清晰度测试字表的建立和临床应用研究[J].上海口腔医学,1995,4(3):125-127.
[5] 王丽萍.吞咽障碍的诊断与评价[J].听力学及言语医学疾病,2008,16(4):275-278.
[6] Chan RC,Wei FC,Wong JK,et al.Is distal fibular fracture an absolute contraindication to free fibular flap harvesting?a review of evidence in the literature and illustration by a successful case[J].Microsurgery,2015,35(1):60-63.
[7] Jiang FF,Hou Y,Lu L,et al.Functional evaluation of a CAD/CAM prosthesis for immediate defect repair after total maxillectomy:a case series of 18 patients with maxillary sinus cancer[J].J Esthet Restor Dent,2015,27(Suppl 1):S80-89.
[8] Kar S,Tripathi A.Treatment outcome with delayed maxillary obturator prosthesis:case series of four patients[J].J Prosthodont,2016,25(2):174-177.
[9] Sinha D,Banerjee S,Chowdhury S.Fabrication of an immediate surgical obturator for a patient with resection of the maxillary antrum and bony orbital floor[J].J Prosthet Dent,2014,112(2):376-378.
[10] Zhang WB,Wang Y,Liu XJ,et al.Reconstruction of maxillary defects with free fibula flap assisted by computer techniques[J].J Craniomaxillofac Surg,2015,43(5):630-636.
[11] K??ri?inen M,Kuuskeri M,Gremoutis G,et al.Utilization ofthree-dimensional computer-Aided preoperative virtual planning and manufacturing in maxillary and mandibular reconstruction with a microvascular fibula flap[J].J Reconstr Microsurg,2016,32(2):137-141.
[12] Li P,Xuan M,Liao C,et al.Application of intraoperative navigation for the reconstruction of mandibular defects with microvascular fibular flaps-preliminary clinical experiences[J].J Craniofac Surg,2016,27(3):751-755.
[13] Lenox ND,Kim DD.Maxillary reconstruction[J].Oral Maxillafac Surg Clim North Am,2013,25(2):215-222.
[14] 徐君伍.口腔修复理论与临床[M].北京:人民卫生出版社,1999 :88-93.
[15] Berssenbrügge P,Berlin NF,Kebeck G,et al.2D and 3D analysis methods of facial asymmetry in comparison[J].J Craniomaxillofac Surg,2014,42(6):e327-334.
[16] Kook MS,Jung S,Park HJ,et al.A comparison study of different facial soft tissue analysis methods[J].J Craniomaxillofac Surg,2014,42(5):648-656.
[17] Zhao YJ,Xiong YX,Wang Y.Three-dimensional accuracy of facial scan for facial deformities in clinics:a new evaluation method for facial scanner accuracy[J].PLoS One,2017,12(1):e0169402.
[18] Chen C,Ren W,Gao L,et al.Function of obturator prosthesis after maxillectomy and prosthetic obturator rehabilitation[J].Braz J Otorhinolaryngol,2016,82(2):177-183.
[19] Noh K,Pae A,Lee JW,et al.Fabricating a tooth-and implant-supported maxillary obturator for a patient after maxillectomy with computer-guided surgery and CAD/CAM technology:a clinical report[J].J Prosthet Dent,2016,115(5):637-642.
[20] Roy AA,Efanov JI,Mercier-Couture G,et al.Zygomatico-maxillary reconstruction with computer-aided manufacturing of a free DCIA osseous flap and intraoral anastomoses[J].Plast Reconstr Surg Glob Open,2017,5(2):e1226.