■由于复杂的下颌骨重建历来具有挑战性,高度功能性,和解剖学的美学性质。这些需要切除的缺陷最常见的病因包括创伤,良性肿瘤,和恶性病理学。下颌骨缺损的治疗很少考虑神经重建,使患者的口头无能与相关的社会耻辱。尽管重建技术的最新进展改善了口腔康复,即刻下牙槽神经(IAN)重建尚未广泛适应。
■在这里,我们寻求讨论大段下颌骨缺损和相关IAN缺损的神经重建的创新,并提出了在圣地亚哥海军医学中心(NMCSD)进行的示例案例。
■讨论使用自体神经收获和同种异体移植的颌面部重建和神经修复的相关文献可从可用的在线资源中查询。
■在过去的三年中,有6名患者使用处理过的同种异体神经移植立即接受了IAN的重建。所有在手术后六个月内获得了对S3的感觉。
■IAN修复使用神经同种异体移植结合游离皮瓣重建治疗下颌骨大缺损是一种可行的治疗方法,应该是颌面部重建的新范例,因为它提供了实质性的可量化和定性的改善社会,功能,和护理的美学结果。
UNASSIGNED: Mandibular reconstruction has historically been challenging due to the complex, highly functional, and esthetic nature of the anatomy. The most common etiologies of these defects requiring resection include trauma, benign tumors, and malignant pathology. Mandibular defects have been treated with little consideration for neural reconstruction, leaving patient\'s orally incompetent with associated social stigma. Although recent advances in reconstructive techniques improve oral rehabilitation, immediate inferior alveolar nerve (IAN) reconstruction has not been widely adapted.
UNASSIGNED: Here-in we seek to discuss the innovations of neural reconstruction of large segment mandibular defects and associated IAN defects and present an example case performed at Naval Medical Center San Diego (NMCSD).
UNASSIGNED: Pertinent literature discussing maxillofacial reconstruction and nerve repair using autogenous nerve harvest and allograft was queried from available online resources.
UNASSIGNED: Six patients have received immediate reconstruction of the IAN using processed nerve allograft over the past three years. All obtained sensation to S3 within six months of surgery.
UNASSIGNED: IAN repair using nerve allografts in conjunction with free flap reconstruction for large mandibular defects is a viable treatment and should be the new paradigm in maxillofacial reconstruction as it provides substantial quantifiable and qualitative improvements in social, functional, and esthetic outcomes of care.