功能优先的新型下颌骨缺损分类(COM)法及临床应用
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摘要
下颌骨缺损多由良恶性肿瘤切除、创伤和感染所致,会导致患者不同程度的颜面畸形和生理功能障碍。下颌骨缺损具有复杂性,不同部位、范围的缺损,将产生不同程度的形态和功能损害,相应的修复重建难度也不相同。因此,下颌骨缺损的精准分类对功能性重建及术后康复意义重大。本文在前期大量临床实践基础上提出了新的基于髁区(condyle region)、牙合区(occlusion region)和肌区(muscle region)3大不同功能区域的新型下颌骨缺损分类方法 ,即COM法,希望有助于下颌骨的功能性修复重建指导及康复效果预测。
Mandibular defects are mostly caused by resection of benign and malignant tumors, trauma and infection,which can lead to different degrees of facial deformity and physiological dysfunction. Mandibular defects are complex, and different parts and ranges of defects will produce different degrees of morphological and functional damage, and the subsequent repair and reconstruction difficulties are also different. Therefore, accurate classification of mandibular defects is of great significance for functional reconstruction and postoperative rehabilitation. Based on a large number of previous clinical practices, this paper proposed a new classification method for mandibular defects based on three different functional areas: condyle region, occlusion region and muscle region, namely COM method. It is elaborated here and hopes to help repair guidance and prediction of rehabilitation effects.
Mandibular defects are mostly caused by resection of benign and malignant tumors, trauma and infection,which can lead to different degrees of facial deformity and physiological dysfunction. Mandibular defects are complex, and different parts and ranges of defects will produce different degrees of morphological and functional damage, and the subsequent repair and reconstruction difficulties are also different. Therefore, accurate classification of mandibular defects is of great significance for functional reconstruction and postoperative rehabilitation. Based on a large number of previous clinical practices, this paper proposed a new classification method for mandibular defects based on three different functional areas: condyle region, occlusion region and muscle region, namely COM method. It is elaborated here and hopes to help repair guidance and prediction of rehabilitation effects.
引文
[1] Boyd JB, Gullane PJ, Rotstein LE, et al. Classification of mandibular defects[J]. Plast Reconstr Surg, 1993, 92(7):1266-1275.
[2] Pavlov BL. Classification of mandibular defects[J]. Stomatologiia(Mosk), 1974, 53(5):43-46.
[3] David DJ, Tan E, Katsaros J, et al. Mandibular reconstruction with vascularized iliac crest:a 10-year experience[J]. Plast Reconstr Surg, 1988, 82(5):792-803.
[4] Jewer DD, Boyd JB, Manktelow RT, et al. Orofacial and mandibular reconstruction with the iliac crest free flap:a review of 60 cases and a new method of classification[J]. Plast Reconstr Surg, 1989, 84(3):391-403, 404-405.
[5] Urken ML, Weinberg H, Vickery C, et al. Oromandibular reconstruction using microvascular composite free flaps. Report of71 cases and a new classification scheme for bony, soft-tissue,and neurologic defects[J]. Arch Otolaryngol Head Neck Surg,1991, 117(7):733-744.
[6] Sakakibara A, Hashikawa K, Yokoo S, et al. Risk factors and surgical refinements of postresective mandibular reconstruction:a retrospective study[J]. Plast Surg Int, 2014, 2014:893746.
[7] Brown JS, Barry C, Ho M, et al. A new classification for mandibular defects after oncological resection[J]. Lancet Oncol,2016, 17(1):e23-e30.
[8]张庆福,吕春堂.下颌骨节段性缺损的分类和修复重建[J].口腔颌面外科杂志, 2006, 16(3):270-273.
[9]李静远,廖贵清.下颌骨缺损分类进展[J].中华口腔医学研究杂志(电子版), 2017, 11(2):115-118.
[10] Iizuka T, Hafliger J, Seto I, et al. Oral rehabilitation after mandibular reconstruction using an osteocutaneous fibula free flap with endosseous implants. Factors affecting the functional outcome in patients with oral cancer[J]. Clin Oral Implants Res,2005, 16(1):69-79.
[11] Schultz BD, Sosin M, Nam A, et al. Classification of mandible defects and algorithm for microvascular reconstruction[J]. Plast Reconstr Surg, 2015, 135(4):743e-754e.
[12]王志平,吴汉江,朱兆夫.下颌骨缺损的外形修复与功能重建[J].口腔颌面外科杂志, 2002, 12(1):61-63.
[13] Zhang C, Ruan M, Xu L, et al. Dental implant distractor combined with free fibular flap:a new design for simultaneous functional mandibular reconstruction[J]. J Oral Maxillofac Surg,2012, 70(11):2687-2700.
[14]张陈平.下颌骨重建的基础与临床[M].上海:上海科技教育出版社, 2009.
[2] Pavlov BL. Classification of mandibular defects[J]. Stomatologiia(Mosk), 1974, 53(5):43-46.
[3] David DJ, Tan E, Katsaros J, et al. Mandibular reconstruction with vascularized iliac crest:a 10-year experience[J]. Plast Reconstr Surg, 1988, 82(5):792-803.
[4] Jewer DD, Boyd JB, Manktelow RT, et al. Orofacial and mandibular reconstruction with the iliac crest free flap:a review of 60 cases and a new method of classification[J]. Plast Reconstr Surg, 1989, 84(3):391-403, 404-405.
[5] Urken ML, Weinberg H, Vickery C, et al. Oromandibular reconstruction using microvascular composite free flaps. Report of71 cases and a new classification scheme for bony, soft-tissue,and neurologic defects[J]. Arch Otolaryngol Head Neck Surg,1991, 117(7):733-744.
[6] Sakakibara A, Hashikawa K, Yokoo S, et al. Risk factors and surgical refinements of postresective mandibular reconstruction:a retrospective study[J]. Plast Surg Int, 2014, 2014:893746.
[7] Brown JS, Barry C, Ho M, et al. A new classification for mandibular defects after oncological resection[J]. Lancet Oncol,2016, 17(1):e23-e30.
[8]张庆福,吕春堂.下颌骨节段性缺损的分类和修复重建[J].口腔颌面外科杂志, 2006, 16(3):270-273.
[9]李静远,廖贵清.下颌骨缺损分类进展[J].中华口腔医学研究杂志(电子版), 2017, 11(2):115-118.
[10] Iizuka T, Hafliger J, Seto I, et al. Oral rehabilitation after mandibular reconstruction using an osteocutaneous fibula free flap with endosseous implants. Factors affecting the functional outcome in patients with oral cancer[J]. Clin Oral Implants Res,2005, 16(1):69-79.
[11] Schultz BD, Sosin M, Nam A, et al. Classification of mandible defects and algorithm for microvascular reconstruction[J]. Plast Reconstr Surg, 2015, 135(4):743e-754e.
[12]王志平,吴汉江,朱兆夫.下颌骨缺损的外形修复与功能重建[J].口腔颌面外科杂志, 2002, 12(1):61-63.
[13] Zhang C, Ruan M, Xu L, et al. Dental implant distractor combined with free fibular flap:a new design for simultaneous functional mandibular reconstruction[J]. J Oral Maxillofac Surg,2012, 70(11):2687-2700.
[14]张陈平.下颌骨重建的基础与临床[M].上海:上海科技教育出版社, 2009.