下顎扁平上皮癌手術における下顎骨の切除方法および即時再建に関する研究

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The management of mandible and immediate reconstruction of mandibular defect following surgery for squamous cell carcinoma of the mandible were discussed in this article. The method of mandibular resection was divided into three groups: 1) marginal resection, 2) segmental resection, and 3) hemimandiblectomy. The case number of the first group was one and that of the second group was thirty four and the thrid group was two, respectively. Mesial and distal margin of the mandibular resection was determined by preoperative radiologic assessment, consisting of panoramic tomography, computed tomography and <SUP>99</SUP>Tc MDP scintigraphy.<BR>The method of immediate reconstruction of the mandible was classified into four groups: 1) primary suture without reconstruction, 2) reconstruction of the mandibular bone alone, 3) reconstruction of the soft tissue alone, and 4) reconstruction of both bone and soft tissue. In these four groups, combined reconstruction of the mandibular bone by AO plate and soft tissue with PM-MC flap or forearm flap have produced more satisfactory results from the standpoints of facial symmetry, low local infectious probability and masticatory function by residual teeth.<BR>In view of clinical problems such as local infection and difficulty of tissue reconstruction in a previously irradiated field, it was considered that vascularized bone and soft tissue transfer had some advantages.
社団法人日本口腔外科学会の論文