■修复牙齿咬合和口腔康复是功能性颌骨重建的最终目标。
■评估预构腓骨瓣(PFF)技术在咬合驱动的颌骨重建中用于良性或先前治疗的恶性疾病。
■这项队列研究于2000年1月至2019年12月在阿尔伯塔大学医院和埃德蒙顿医学重建科学研究所进行,艾伯塔省,加拿大,在接受PFF或骨驱动和延迟骨整合植入物安装(BDD)的患者中。患者在咬合康复后至少随访1年。数据从2021年7月到2022年6月进行了分析。
■接受BDD或PFF的患者,其中包括骨整合牙种植体安装和腓骨植皮3至6个月前颌骨肿瘤切除或缺损重建。种植体骨整合在颌骨重建时完成,允许全面重建,加载,并在术后即刻恢复牙合。
■安全,有效性,准确度,咬合重建的及时性,比较了PFF和BDD的审美情趣。各组比较以下变量:术后并发症,使用的骨段数量,需要的程序数量,总手术时间,咬合康复的时间,以及安装的植入物的数量,暴露,丢失,并使用(即,暴露的植入物-丢失的植入物)。使用手术前和手术后6至12个月拍摄的标准化全脸和轮廓数码照片评估美学吸引力,并由3名幼稚评估者进行分析。
■在9名接受PFF的患者中(平均[SD]年龄,43.3[13.0]岁;7名男性[77.8%])和12名接受BDD的患者(平均[SD]年龄,41.9[18.0]年;8名男性[66.7%]),总并发症发生率相似(4例[44.4%]vs3例[25.0%],分别是;相对风险,1.78[95%CI,0.52至6.04])。PFF和BDD组的植入物丢失患者数量相似(0例vs3例[25.0%],分别;差异,-25.0个百分点[95%CI,-48.4至9.7个百分点])。与BDD相比,PFF具有临床意义的平均(SD)更快的咬合康复(12.1[1.9]个月比60.4[23.1]个月;差异,-48.3个月[95%CI,-64.5至-32.0个月])。PFF组和BDD组之间术前到术后美学评分的平均(SD)差异相似(-0.8[1.5]vs-0.2[0.8];差异,-0.6[95%CI,-1.6至0.4])。
■这项研究发现,PFF与BDD相比是安全的,有效,良性或先前治疗的颌骨恶性肿瘤患者的美学重建选择。该技术可以提供快速的咬合重建和口腔康复。
UNASSIGNED: Restoration of dental occlusion and oral rehabilitation is the ultimate goal of functional jaw reconstruction.
UNASSIGNED: To evaluate the prefabricated fibula flap (PFF) technique in occlusion-driven jaw reconstruction for benign or previously treated malignant disease.
UNASSIGNED: This cohort study was conducted from January 2000 to December 2019 at the University of Alberta Hospital and Institute of Reconstructive Sciences in Medicine in Edmonton, Alberta, Canada, among patients who underwent PFF or bone-driven and delayed osseointegrated implant installation (BDD). Patients were followed up for a minimum of 1 year after occlusal rehabilitation. Data were analyzed from July 2021 to June 2022.
UNASSIGNED: Patients underwent BDD or PFF, which consists of osseointegrated dental implant installation and skin grafting of the fibular bone 3 to 6 months before jaw tumor resection or defect reconstruction. The implant osseointegration is completed at the time of jaw reconstruction, allowing for full reconstruction, loading, and restoration of the dental occlusion in the immediate postoperative period.
UNASSIGNED: Safety, effectiveness, accuracy, timeliness of occlusal reconstruction, and aesthetic appeal were compared between PFF and BDD. Groups were compared for the following variables: postoperative complications, number of bony segments used, number of procedures needed, total operative time, time to occlusal rehabilitation, and number of implants installed, exposed, lost, and used (ie, exposed implants - lost implants). Aesthetic appeal was assessed using standardized full-face and profile digital photographs taken before and 6 to 12 months after the operation and analyzed by 3 naive raters.
UNASSIGNED: Among 9 patients receiving PFF (mean [SD] age, 43.3 [13.0] years; 7 men [77.8%]) and 12 patients receiving BDD (mean [SD] age, 41.9 [18.0] years; 8 men [66.7%]), the overall complication rate was similar (4 patients [44.4%] vs 3 patients [25.0%], respectively; relative risk, 1.78 [95% CI, 0.52 to 6.04]). The number of patients with implant loss was similar between PFF and BDD groups (0 patients vs 3 patients [25.0%], respectively; difference, -25.0 percentage points [95% CI, -48.4 to 9.7 percentage points]). PFF had a clinically meaningful faster mean (SD) occlusal rehabilitation compared with BDD (12.1 [1.9] months vs 60.4 [23.1] months; difference, -48.3 months [95% CI, -64.5 to -32.0 months]). The mean (SD) difference in preoperative to postoperative aesthetic score was similar between PFF and BDD groups (-0.8 [1.5] vs -0.2 [0.8]; difference, -0.6 [95% CI, -1.6 to 0.4]).
UNASSIGNED: This study found that PFF compared with BDD was a safe, effective, and aesthetic reconstructive option for patients with benign or previously treated jaw malignant tumors. This technique may provide rapid occlusal reconstruction and oral rehabilitation.