背景:已经提出了肿瘤切除术后的几种下颌骨缺损分类,但未被外科医生和修复医生普遍接受。缺乏描述这些下颌骨切除术缺陷的既定标准。
目的:本系统综述的目的是分析科学文献中可用的下颌骨缺损分类系统,提供批判性评估,并确定通用描述下颌不连续缺陷所需的标准。
方法:在2个电子数据库(PubMed和CochraneLibrary)上对1971年至2020年之间的英语文献进行了电子搜索。使用MeSH术语和自由文本词进行搜索:下颌骨肿瘤和下颌骨重建或下颌骨切除术或下颌骨缺损和分类,其次是纳入和排除标准的应用。描述下颌骨放射性骨坏死分类的研究,下颌骨骨折,下颌阻生第三磨牙,下颌牙髓或牙周治疗不包括在内。对选定文章的全文进行了深入审查,以提供批判性评估。将每个分类系统的各种描述性因素制成表格,以确定适合下颌不连续性缺陷通用描述的标准。
结果:电子搜索共产生239个标题和摘要。其中,与审查相关的52个标题由2名审查者独立确定。排除那些不符合预定纳入标准和重复的研究。通过回顾21项选定的研究并应用排除标准,选择了12项研究进行全文阅读。在选定出版物的参考文献中进行了手动搜索,这又产生了一篇符合纳入标准的文章。因此,最终审查共有13篇全文。经过对选定的分类系统的相关信息进行进一步的定性分析和制表,提出了8个描述性标准和金字塔分层图,其中包括骨缺陷的程度,软组织缺损,牙齿状况,下颌功能,神经状况,髁状态,重建类型,联合切除。
结论:下颌骨切除术后缺损患者的频谱差异很大。最理想的分类系统的问题仍未解决。下颌不连续性缺陷描述的八个不同标准和提出的金字塔分层图将使外科医生和修复医生更好地沟通和概念化个性化的手术和修复治疗计划。
BACKGROUND: Several mandibular defect classifications after oncological resection have been proposed with no universal acceptance among surgeons and prosthodontists. Established criteria for describing these mandibulectomy defects are lacking.
OBJECTIVE: The purpose of this systematic
review was to analyze the classification systems of mandibular defects available in the scientific literature, provide a critical appraisal, and identify the criteria necessary for a universal description of mandibular discontinuity defects.
METHODS: An electronic search of the English language literature between 1971 and 2020 was performed on 2 electronic databases (PubMed and Cochrane Library). The search was conducted using MeSH terms and free text words: Mandible neoplasm AND Mandibular reconstruction OR Mandible resection OR Mandible defect AND classification, followed by the application of inclusion and exclusion criteria. Studies describing the classification of osteoradionecrosis of the mandible, mandibular fracture, impacted mandibular third molar, and mandibular endodontic or periodontal treatment were not included. The full texts of selected articles were reviewed in depth to provide a critical appraisal. The various descriptive factors of each classification system were tabulated to identify criteria suitable for the universal description of mandibular discontinuity defects.
RESULTS: The electronic search yielded a total of 239 titles and abstracts. Of these, 52 titles relevant to the
review were identified by the 2 reviewers independently. Those studies that did not match the predetermined inclusion criteria and duplicates were excluded. By reviewing the 21 selected studies and applying exclusion criteria, 12 studies were selected for full-text reading. A manual search in the references of the selected publications was performed, which yielded 1 additional article that satisfied the inclusion criteria. Thus, a total of 13 full-text articles were included in the final
review. After further qualitative analysis and tabulation of relevant information from selected classification systems, the 8 descriptive criteria and a pyramidal hierarchical chart were proposed that included the extent of bony defect, soft tissue defect, dental status, mandibular function, neurological status, condyle status, type of reconstruction, and combined resection.
CONCLUSIONS: The spectrum of patients with mandibulectomy defects following resection varies greatly. The question of the most ideal classification system remains unresolved. Eight different criteria for the description of mandibular discontinuity defects and the pyramidal hierarchical chart proposed will allow surgeons and prosthodontists to better communicate and conceptualize an individualized surgical and prosthetic treatment plan.