Innovative one fibula - two segmental mandibular reconstruction with a second orthognathic surgery for bilateral mandibular body resorption.

IF 3.4 2区 医学 Q1 SURGERY
Hongwei Wang, Dongming He, Kai Liu, Jingshuang Yu, Hao Sun, Feini Zeng, Min Zhu, Lei Zhang, Jian Cao, Xudong Wang
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引用次数: 0

Abstract

Summary: Patients with bilateral mandibular resorption and malunion after bilateral sagittal split osteotomy (BSSO) presented with an anterior open bite, chin retrusion, and facial deformity, necessitating a second orthognathic surgery and jaw reconstruction. Due to the rarity and unclear etiology of this complication, careful selection of repair techniques is imperative for managing such discontinuous mandibular defects. Patient demands, such as concealed surgical incisions, fewer operations, high success rates, and accurate outcomes, should be considered, specifically in young females. Following virtual surgery for occlusion correction, as well as condyle and mandibular ramus repositioning, the extent of bilateral defects can be assessed. After weighing all reconstructive options, two separate vascularized fibula free flaps, prepared from a single fibular donor site, were selected for bilateral reconstruction. To effectively address intraoperative changes and enhance contact area between the fibular segments and mandibular rami, a sliding design, modified step-cut osteotomy, and length-gradient titanium plates were adopted. With the aid of 3D-printed osteotomy guides and titanium plates, the surgical procedure was successfully performed according to the predetermined design through bilateral Risdon incisions. Favorable postoperative healing, a stable occlusal relationship, a well-formed mandible, and improved facial aesthetics were successfully achieved at a two-year follow-up.

创新的一腓骨-两节段下颌骨重建与第二次正颌手术的双侧下颌骨身体吸收。
摘要:双侧矢状劈开截骨术(BSSO)后双侧下颌吸收和不愈合的患者表现为前开咬、下巴后缩和面部畸形,需要进行第二次正颌手术和下颌重建。由于这种并发症的罕见性和不明确的病因,仔细选择修复技术是处理这种下颌不连续缺损的必要条件。应考虑患者的需求,如隐藏手术切口、较少手术、高成功率和准确的结果,特别是在年轻女性中。通过虚拟手术进行咬合矫正,以及髁突和下颌支重新定位,可以评估双侧缺陷的程度。在权衡所有重建方案后,选择两个独立的带血管的腓骨游离皮瓣,从单个腓骨供区制备,用于双侧重建。为有效应对术中变化,增加腓骨节段与下颌支的接触面积,采用滑动设计、改良步切截骨、长度梯度钛板。借助3d打印截骨导板和钛板,通过双侧Risdon切口,按照预定设计成功完成手术。术后良好的愈合,稳定的咬合关系,良好的下颌骨,改善的面部美学在两年的随访中成功实现。
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来源期刊
CiteScore
5.00
自引率
13.90%
发文量
1436
审稿时长
1.5 months
期刊介绍: For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis. Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.
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