同期神经化腓骨瓣用于下颌骨重建及下唇感觉恢复的术式初探

doi:10.19438/j.cjoms.2024.02.005

中国口腔颌面外科杂志 ›› 2024, Vol. 22 ›› Issue (2): 143-147.doi: 10.19438/j.cjoms.2024.02.005

同期神经化腓骨瓣用于下颌骨重建及下唇感觉恢复的术式初探

张冰清¹, 史敬存¹, 吴梓谦¹, 张于涵¹, 王婕妤¹, 肖孟¹, 王磊^1,2

1.上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室, 上海市口腔医学研究所,上海 200125;
2.上海市奉贤区奉城医院口腔颌面-头颈肿瘤科,上海 201411

收稿日期:2023-11-28 修回日期:2023-12-25 出版日期:2024-02-20 发布日期:2024-03-27
通讯作者: 王磊,E-mail: wangleizyh@aliyun.com
作者简介:张冰清（1999-）,女,硕士研究生,E-mail: hassan0606@163.com
基金资助:
国家自然科学基金（81970907）; 上海市卫生健康委员会卫生行业临床研究专项（202340135）

A primary study on application of neuralized fibula flap for mandibular reconstruction and sensory restoration of the lower lip

ZHANG Bing-qing¹, SHI Jing-cun¹, WU Zi-qian¹, ZHANG Yu-han¹, WANG Jie-yu¹, XIAO Meng¹, WANG Lei^1,2

1. Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology. Shanghai 200125;
2. Department of Oromaxillofacial Head and Neck Oncology, Fengcheng Hospital, Fengxian District. Shanghai 201411, China

Received:2023-11-28 Revised:2023-12-25 Online:2024-02-20 Published:2024-03-27

摘要/Abstract

摘要： 目的: 探讨下颌骨及下牙槽神经因肿瘤截除后,同期颌骨重建及感觉恢复的新方法,为临床提供参考。方法: 对1例下颌骨成釉细胞瘤患者行下颌骨节段性切除,术中一并切除与病灶密切的下牙槽神经,同期行神经化血管化腓骨游离皮瓣移植修复。术后通过影像学观察其移植骨吸收情况,应用两点辨别觉和感觉测试丝评估感觉保存效果。结果: 术后随访9个月,患者颜面自然对称,皮瓣存活良好,移植骨稳定未见明显吸收,下唇感觉功能良好,颏部稍次,无咬唇、流涎等问题;受区及供区未见并发症。结论: 同期重建神经的新方法对腓骨瓣移植重建下颌骨时恢复下唇感觉及预防移植骨术后吸收具有较好效果。

关键词: 腓骨瓣, 神经吻合, 下颌骨缺损, 颌骨重建

Abstract: PURPOSE: To explore a new method of simultaneous jaw reconstruction and sensory recovery after resection of the mandible and inferior alveolar nerve due to tumor, so as to provide reference for clinical practice. METHODS: Segmental resection of mandibular bone was performed in a patient with mandibular ameloblastoma. The inferior alveolar nerve closely associated with the lesion was removed during the operation, neurovascularized fibula free flap was transplanted at the same time. The graft resorption was observed by postoperative imaging, and sensory preservation was evaluated by applying two-point discriminative sensation and touch test using sensory test wire. RESULTS: At the 9-month postoperative follow-up, the patient exhibited a naturally symmetrical facial appearance, with the flap displaying excellent survival and blood supply. The grafted bone remained stable without noticeable resorption, and the lower lip regained good sensory function while sensory function was partially restored to the chin. There were no issues such as lip-biting or salivation. Furthermore, neither recipient nor donor areas exhibited adverse complications. CONCLUSIONS: This innovative approach of simultaneous nerve reconstruction demonstrates promising efficacy in restoring lower lip sensation and preventing postoperative grafted bone resorption in fibula flap transplantation for mandibular reconstruction.

Key words: Fibula flap, Nerve anastomosis, Mandibular defect, Jaw reconstruction

中图分类号:

R782.2

张冰清, 史敬存, 吴梓谦, 张于涵, 王婕妤, 肖孟, 王磊. 同期神经化腓骨瓣用于下颌骨重建及下唇感觉恢复的术式初探[J]. 中国口腔颌面外科杂志, 2024, 22(2): 143-147.

ZHANG Bing-qing, SHI Jing-cun, WU Zi-qian, ZHANG Yu-han, WANG Jie-yu, XIAO Meng, WANG Lei. A primary study on application of neuralized fibula flap for mandibular reconstruction and sensory restoration of the lower lip[J]. China J Oral Maxillofac Surg, 2024, 22(2): 143-147.

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同期神经化腓骨瓣用于下颌骨重建及下唇感觉恢复的术式初探

A primary study on application of neuralized fibula flap for mandibular reconstruction and sensory restoration of the lower lip

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