Abstract：
OBJECTIVE: Microvascular bone flap jaw reconstruction has achieved satisfactory clinical outcomes. However, little is known about the long-term stability of the reconstructed jaw. This prospective longitudinal study aimed to investigate the long-term stability of jaw reconstruction and factors that were associated with it.
METHODS: Patients with successful computer-assisted osseous free-flap jaw reconstruction in the Department of Oral and Maxillofacial Surgery, Queen Mary Hospital, Hong Kong were recruited for this prospective longitudinal study. The three-dimensional jaw models at the pre-operative plan, post-operative 1-month, and 2 years were aligned and compared.
RESULTS: A total of 69 patients were recruited, among which 48 patients were available for the long-term analysis. Compared to 1-month after surgery, further deviation from the pre-operative plan was observed at post-operative 2 years. Lack of accuracy in surgery, segmental mandible resection especially with the involvement of mandible angles, and post-operative radiation therapy were identified as the significant factors affecting the positional stability of the reconstructed jaw (p < 0.05). Stable reconstruction was observed in the subgroup analysis of patients without post-operative radiation therapy.
CONCLUSIONS: Up to the best of our knowledge, this is the first prospective longitudinal study reporting the long-term stability of jaw reconstruction and its affecting factors. Our data demonstrated that the reconstructed jaw position lacked stability over the postoperative period. How to improve long-term stability of reconstructed jaw thus optimize the functional outcomes warrants further studies.
METHODS: Patients with successful computer-assisted osseous free-flap jaw reconstruction in the Department of Oral and Maxillofacial Surgery, Queen Mary Hospital, Hong Kong were recruited for this prospective longitudinal study. The three-dimensional jaw models at the pre-operative plan, post-operative 1-month, and 2 years were aligned and compared.
RESULTS: A total of 69 patients were recruited, among which 48 patients were available for the long-term analysis. Compared to 1-month after surgery, further deviation from the pre-operative plan was observed at post-operative 2 years. Lack of accuracy in surgery, segmental mandible resection especially with the involvement of mandible angles, and post-operative radiation therapy were identified as the significant factors affecting the positional stability of the reconstructed jaw (p < 0.05). Stable reconstruction was observed in the subgroup analysis of patients without post-operative radiation therapy.
CONCLUSIONS: Up to the best of our knowledge, this is the first prospective longitudinal study reporting the long-term stability of jaw reconstruction and its affecting factors. Our data demonstrated that the reconstructed jaw position lacked stability over the postoperative period. How to improve long-term stability of reconstructed jaw thus optimize the functional outcomes warrants further studies.
摘要：
目的：微血管骨瓣颌骨重建取得了满意的临床效果。然而,对重建颌骨的长期稳定性知之甚少。这项前瞻性纵向研究旨在研究颌骨重建的长期稳定性及其相关因素。
方法：口腔颌面外科计算机辅助骨性游离皮瓣下颌骨重建成功的患者，玛丽医院,这项前瞻性纵向研究招募了香港。术前计划的三维颌骨模型，术后1个月,和2年进行了对齐和比较。
结果：共招募了69名患者，其中48例患者可用于长期分析.与手术后1个月相比，术后2年观察到进一步偏离术前计划.手术缺乏准确性，节段性下颌骨切除，尤其是涉及下颌骨的角度，术后放射治疗被确定为影响重建颌骨位置稳定性的显著因素(p<0.05)。在未接受术后放射治疗的患者的亚组分析中观察到稳定的重建。
结论：据我们所知，这是第一个前瞻性纵向研究报告颌骨重建的长期稳定性及其影响因素。我们的数据表明，重建的下颌位置在术后期间缺乏稳定性。如何提高重建颌骨的长期稳定性，从而优化功能结果，值得进一步研究。
方法：口腔颌面外科计算机辅助骨性游离皮瓣下颌骨重建成功的患者，玛丽医院,这项前瞻性纵向研究招募了香港。术前计划的三维颌骨模型，术后1个月,和2年进行了对齐和比较。
结果：共招募了69名患者，其中48例患者可用于长期分析.与手术后1个月相比，术后2年观察到进一步偏离术前计划.手术缺乏准确性，节段性下颌骨切除，尤其是涉及下颌骨的角度，术后放射治疗被确定为影响重建颌骨位置稳定性的显著因素(p<0.05)。在未接受术后放射治疗的患者的亚组分析中观察到稳定的重建。
结论：据我们所知，这是第一个前瞻性纵向研究报告颌骨重建的长期稳定性及其影响因素。我们的数据表明，重建的下颌位置在术后期间缺乏稳定性。如何提高重建颌骨的长期稳定性，从而优化功能结果，值得进一步研究。
