本研究旨在介绍一种新颖的环形神经吻合技术,该技术使用带有血管化髂腹股沟神经(IIN)的神经支配血管化髂骨瓣(VIBF)重建下牙槽神经(IAN)并在下颌重建的同时保持下唇感觉。
这项研究前瞻性地纳入了2018年5月至2020年4月使用VIBF进行下颌骨重建的患者。将受试者分为两组:(1)第一组;神经支配的VIBF伴环形神经吻合(IIN与IAN和精神神经双重吻合),(2)第II组(对照);常规VIBF。根据手术时间进行评估,术中吲哚菁绿(ICG),下唇感觉评估(两点辨别[TPD]测试和当前感知阈值[CPT]),流口水.
纳入12例患者;每组6例,(7名男性和5名女性),年龄18~57岁(平均36.75岁)。在所有情况下,术中IIN灌注通过ICG证实。与II组相比,I组显示出更多的皮瓣收获时间具有统计学意义(平均差异,5.67分钟;P=0.0091)。感觉恢复有利于I组,差异有统计学意义(P<0.05)。第一组的TPD结果显示,手术侧和非手术侧的平均为9.8±6.9mm和6.2±5.7mm,而第二组的感官恢复较差,手术侧和非手术侧的TPD平均为24.6±6.7mm和8.4±2.3mm。CPT结果显示两组之间存在显着差异。在第一组中,流口水的程度为3.16±0.75,而在第二组中,得分为1.6±0.81,显示出有利于I组的显着差异。
使用VIBF和血管化IIN的loop神经吻合术的并发下颌骨重建IAN可以成功恢复下颌骨形态并保持唇感。
This study aimed to introduce a novel loop neurorrhaphy technique using an innervated vascularized iliac bone flap (VIBF) with vascularized ilioinguinal nerve (IIN) to reconstruct the inferior alveolar nerve (IAN) and preserve lower lip sensation simultaneously with mandibular reconstruction.
This study prospectively included patients who underwent mandibular reconstruction using VIBF from May 2018 to April 2020. Subjects were allocated into two groups: (1) Group I; innervated VIBF with loop neurorrhaphy (IIN doubly anastomosed with IAN and mental nerve), (2) Group II (control); conventional VIBF. Evaluation was done with operative time, intraoperative indocyanine green (ICG), lower lip sensory assessment (two-point discrimination [TPD] test and current perception threshold [CPT]), and drooling.
Twelve patients were included; 6 in each group, (7 males and 5 females), age ranging from 18 to 57 years (average: 36.75 years). In all cases, intraoperative perfusion of IIN was confirmed by ICG. Group I showed a statistically significant more flap harvesting time compared with group II (mean difference, 5.67 min; P = 0.0091). There was a significant difference in sensory recovery favoring group I (P < 0.05). The TPD results in group I showed an average of 9.8 ± 6.9 mm and 6.2 ± 5.7 mm on operated and non-operated sides, while Group II showed a poor sensory recovery, and the TPD showed an average of 24.6 ± 6.7 mm and 8.4 ± 2.3 mm on operated and non-operated sides. The CPT results showed a significant difference between both groups. In Group I, the extent of drooling was 3.16 ± 0.75, while in Group II, the score was 1.6 ± 0.81, revealing a significant difference favoring Group I.
Concurrent mandibular reconstruction using VIBF and loop neurorrhaphy with vascularized IIN to reconstruct IAN successfully restore lower jaw form and preserve lip sensation.