背景:幸运的是,对整个下颌骨重建和双侧关节置换的需求很少,但这在颌面外科是一个极具挑战性的话题,由于其功能影响。CAD-CAM技术的发展为复杂颌面重建的手术计划开辟了新的广阔视野,在准确性方面,可预测性,和功能性美容效果。对文献的回顾揭示了关于包括髁在内的全颌骨切除术的少量科学报告,1980年只有11例。大多数作品描述了继发于影响下颌的发育不良或炎性疾病的重建。这项工作的目的,报告了一个罕见的整个下颌骨大量纤维发育不良的病例,是分享我们在扩展下颌和双侧关节重建管理方面的经验,使用多孔钛患者专用植入物。
方法:作者介绍了一名20岁的男性患者,患有下颌骨大量骨纤维发育不良。下颌骨以及rami和con突都参与其中,导致严重的功能损害,牙齿脱落,和面部变形。年轻的病人,经过多次无效的保守手术治疗,需要进行双关节下颌骨置换。使用虚拟手术计划(VSP)软件,作者,与医学工程师合作,创造了一个定制的原始钛多孔下颌植入物,从双侧人工颞下颌关节悬挂。下颌钛种植体已被专门设计用于支持软组织和固定,在肺泡区域,游离腓骨骨移植,用于延迟种植牙修复。
结论:手术和技术细节,以及使用多孔钛植入物进行下颌重建的新趋势,据报道,并讨论,回顾关于这一主题的文献报道。获得了满意的功能和美容修复效果,无重大并发症发生。病人,目前正在进行第18个月的临床和放射学随访,最近通过植入物支持的全弓假牙完成了功能修复计划。
BACKGROUND: The need for whole mandibular bone reconstruction and bilateral joint replacement is fortunately rare, but it is an extremely challenging topic in maxillofacial surgery, due to its functional implications. CAD-CAM techniques development has opened new broad horizons in the surgical planning of complex maxillofacial reconstructions, in terms of accuracy, predictability, and functional cosmetic results. The
review of the literature has revealed a small number of scientific reports on total mandibulectomy including the condyles, with only eleven cases from 1980. Most of the works describe reconstructions secondary to dysplastic or inflammatory diseases affecting the lower jaw. The aim of this work, reporting a rare case of massive fibrous dysplasia of the whole mandible, is to share our experience in the management of extended mandibular and bilateral joint reconstruction, using porous titanium patient-specific implants.
METHODS: The authors present a 20-year-old male patient suffering from massive bone fibrous dysplasia of the mandible. The mandibular body and both the rami and the condylar processes had been involved, causing severe functional impairment, tooth loss, and facial deformation. The young patient, after repeated ineffective conservative surgical treatments, has required a biarticular mandibular replacement. Using virtual surgical planning (VSP) software, the authors, in collaboration with medical engineers, have created a custom-made original titanium porous mandibular implant, suspended from a bilateral artificial temporomandibular joint. The mandibular titanium implant body has been specifically designed to support soft tissues and to fix, in the alveolar region, a free fibular bone graft, for delayed dental implant prosthetic rehabilitation.
CONCLUSIONS: The surgical and technical details, as well as the new trends in mandibular reconstructions using porous titanium implants, are reported, and discussed, reviewing literature reports on this topic. Satisfactory functional and cosmetic restorative results have been obtained, and no major complications have occurred. The patient, currently in the 18th month clinical and radiological follow-up, has recently completed the functional restoration program by an implant-supported full-arch dental prosthesis.