[Intraoral approach combined with submandibular minor incision for mandibular defect reconstruction using vascularized iliac bone-muscle flap: a clinical study].

内容摘要

Objective: To investigate the clinical efficacy of intraoral approach combined with submandibular minor-incision for simultaneous mandibular resection and precise reconstruction using vascularized iliac bone-muscle flap in patients with benign mandibular lesions. Methods: From January 2023 to January 2026, 19 patients with benign mandibular lesions were enrolled. The cohort comprised 8 males and 11 females, aged 15 to 75 years (mean 46.5 years). Pathological diagnoses included ameloblastoma (n=13), recurrent odontogenic keratocyst (n=2), sclerosing osteomyelitis of the jaw (n=2), giant cell lesion (n=1), and recurrent ossifying fibroma (n=1). All procedures employed an intraoral approach combined with a submandibular minor-incision. Preoperatively, spiral CT scans of the mandible and iliac bone were utilized to construct a mandibular model, and a reconstruction titanium plate was pre-bent using computer-aided design/computer-aided manufacturing (CAD/CAM) technology. All 19 patients underwent unilateral segmental mandibulectomy with in-situ fixation of the pre-bent reconstruction plate, followed by mandibular defect reconstruction using a vascularized iliac bone-muscle flap. Immediate implant placement was performed in 12 cases. Results: Vascularized iliac bone-muscle flaps survived in 18 patients (success rate 95%), while 1 flap failed due to necrosis. All incisions healed primarily. Twelve patients underwent simultaneous implant placement. During the 1-year follow-up, all patients demonstrated satisfactory functional recovery without facial nerve injury. The occlusal relationship of the remaining dentition was basically maintained at the preoperative level. Masticatory function was satisfactory. Mouth opening ranged from 31 to 36 mm. Swallowing and speech functions were normal. Only minor scars (mean length 1.5 cm) were observed extraorally, and patients were satisfied with their facial appearance. The mean initial implant stability quotient value in the 12 implanted patients was (72.5±6.3). CBCT evaluation at 6 months postoperatively revealed an osseointegration rate of 100%. No recurrence was observed up to the last follow-up. Conclusions: Intraoral approach combined with submandibular minor-incision for simultaneous mandibular resection and vascularized iliac bone-muscle flap reconstruction, as preliminarily demonstrated in this small-sample cohort, can shorten operative time, enhance reconstructive precision, reduce maxillofacial scarring, and significantly improve patient satisfaction. It represents a reliable surgical strategy for precise simultaneous mandibular resection and reconstruction. 目的： 探讨采用口内入路联合颌下小切口进行下颌骨切除同期血管化髂骨肌皮瓣精准修复重建的临床效果。 方法： 纳入2023年1月至2026年1月南京大学医学院附属口腔医院口腔颌面头颈外科收治19例下颌骨良性病变患者。其中男性8例，女性11例；年龄15~75岁，平均46.5岁。病理诊断为成釉细胞瘤13例，复发性牙源性角化囊肿2例，颌骨硬化性骨髓炎2例，巨细胞性病变1例，复发性骨化纤维瘤1例。手术均采用口内入路联合颌下小切口。术前利用螺旋CT扫描获取的下颌骨及髂骨数据，通过计算机辅助设计及制作技术制作下颌骨模型，并在该模型上对重建钛板进行预弯塑形。19例患者均行单侧下颌骨节段性切除，同时将弯制重建钛板原位固定，下颌骨缺损区采用血管化髂骨肌瓣修复重建，其中12例行同期即刻种植体植入。 结果： 18例血管化髂骨肌瓣成活（成功率95%），1例髂骨肌瓣坏死，切口均一期愈合；12例行同期种植体植入；随访时间1年，患者功能均恢复良好，无面神经损伤表现，余留牙列咬合关系基本维持术前状态；咀嚼功能满意；开口度31~36 mm；吞咽及语言功能正常。口外仅有轻微瘢痕，长度1.5 cm，患者对面部外形满意。12例同期种植患者种植体的初始稳定性值（72.5±6.3）；术后6个月锥形束CT评估骨结合率100%。截至末次随访均无复发。 结论： 口内入路联合颌下小切口进行下颌骨切除同期血管化髂骨肌瓣修复重建在本小样本队列中初步显示可以缩短手术时间，增加重建精确性，减小颌面部瘢痕，明显提高患者满意度，是下颌骨切除同期精准修复重建的可靠手术方案。.