T-CHSA 020-2023 上颌骨缺损手术功能修复重建的专家共识

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C05中华口腔医学会团 体 标 准T/CHSA020—2023上颌骨缺损手术功能修复重建的专家共识Expertconsensusstatementonsurgicalreconstructionprincipleformandibulardefect2023-05-19发布 2023-06-01实施中华口医学会 发布T/CHSA020T/CHSA020—2023学兔兔标准下载目 次前言 III引言 IV112范引文件 13语定义 14应与忌证 1适1禁15前2上骨损区2损围床2像检查 25.1.3内2供的26建机选择 2一骨2二骨27作2数化据集拟外设计 2血化移重颌骨损供选择 3上骨塑要点 3软织联穿植修上骨3赝治疗 38颌重术的修复 4义修前4组诱成4庭成4常义修方式 4摘齿塞4植支式定义修复 49见发预与4受并4供并5参考献 6II前 言本文件按照GB/T1.1—2020《标准化工作导则第1部分：标准化文件的结构和起草规则》的规定起草。本文件由中华口腔医学会口腔修复学专业委员会提出。本文件由中华口腔医学会归口。III引 言2020年1/32-3IV上颌骨缺损手术功能修复重建的专家共识范围本文件没有规范性引用文件。下列术语和定义适用于本文件。上颌骨缺损maxillarydefects1/3JamesBrown[1-4]血管化骨移植vascularizedbonegrafting（肌穿颧种植联合软组织皮瓣zygomaticimplantationcombinedwithsofttissueflap，ZIP[5]颌面赝复体maxillofacialprosthesis适应证禁忌证1[7]对上颌骨重建的患者推荐进行颌面部螺旋CT扫描和全景片拍摄，如需数字化设计则需要层厚在1mm以下的CT扫描。CTCT（1mm）1/3[8]部分肿瘤患者局部或全身不具备条件即刻修复上颌骨缺损，还有部分长期佩戴赝复体修复效果不数字化治疗方案规划的主要内容包括:2结合拟修复的颌骨外形轮廓与种植体位置角度对参照镜像翻转健侧颌骨模型；越过中线的缺3D手术辅助导板与手术导航是将虚拟设计准确转化到实际手术中的不同方式，可以根据实际情25cm9-10cm优势在于可携带组织量充足的软组织皮岛，可以修复伴有大面积皮肤或复合组织缺损的上颌骨缺损病由于上颌骨的特殊形态，移植骨必须经过塑形才能与之匹配，主要要点为：（JamesBrownI-II7-10（7-1033上颌骨重建患者牙槽嵴表面常有皮瓣或松软肥厚的软组织覆盖，不利于维持健康的种植体周围组植入7.1.1[11,12][13,14]1cmCBCT[15]3（）17,18］。4[18]5参 考 文 献.:[M].北京:,2012..[M].西安:2004.RogersSN,LoweD,McNallyD,etal.Health-relatedqualityoflifeaftermaxillectomy:acomparisonbetweenprostheticobturationandfreeflap.JOralMaxillofacSurg.2003,61(2):174-181.BrownJS,ShawRJ.Reconstructionofthemaxillaandmidface:introducinganewclassification.LancetOncol.2010,11(10):1001-1008.ButterworthCJ,RogersSN.Thezygomaticimplantperforated(ZIP)flap:anewtechniqueforcombinedsurgicalreconstructionandrapidfixeddentalrehabilitationfollowinglow-levelmaxillectomy.IntJImplantDent.2017,3(1):37.TalesnikA，MarkowitzB，CalcaterraT，etal.Costandoutcomeofosteocutaneousfree-tissuetransferversuspedicledsofe-tissuereconstructionforcompositemandibulardefects．PlastReconstr97:1167-1177．RogersSN,LakshmiahSR,NarayanB,etal.AComparisonofthelong-termmorbidityfollowingdeepcircumflexiliacandfibulafreeflapsforreconstructionfollowingheadandneckcancer.PlastReconstrSurg.2003,112(6):1517-1525.MilesBA,GilbertRW.Maxillaryreconstructionwiththescapularangleosteomyogenousfreeflap.ArchOtolaryngolHeadNeckSurg.2011,137(11):1130-1135.GürlekA，MillerMJ，JacobRF，etal．Functionalresultsofdentalrestorationwithosseointegratedimplantsaftermandiblereconstruction．PlastReconstrSurg,1998,101:650-659．O'ConnellDA,FutranND.Reconstructionofthemidfaceandmaxilla.CurrOpinOtolaryngolHeadNeckSurg.2010,18(4):304-310.SalinasTJ,SinhaN,RevuruV,etal.Prostheticrehabilitationofamaxillarydefectwithaboneanchoredprosthesis:aclinicalreport.JProsthetDent.2019,121(1):173-178.DholamKP,SadashivaKM,BhirangiPP.Rehabilitationoflargemaxillarydefectwithtwo-piecemaxillaryobturators.JCancerResTher.2015,11(3):664.Cowardal.Acomparisonofprostheticearmodelscreatedfromdatacapturedbycomputerizedtomography，magneticresonanceimaging，andlaserscanning[J].IntJProsthodont，2007,20(3):275-285.VincentA,BurkesJ,Williamsetal.Freeflapreconstructionofthemaxilla.SeminPlastSurg.2019,33(1):30-37.MiciE,BelliE.FibrousDysplasia:Acomplexmaxillaryreconstruction.JCraniofacSurg.2018,29(7):e660-e661.PangJH,BrookeS,KubikMW,etal.Stagedreconstruction(delayed-immediate)ofthemaxillectomydefectusingCAD/CAMtechnology.JReconstrMicrosurg.2018,34(3):193-199.JangWH,LeeJM,JangS,etal.Mirrorimagebasedthree-dimensionalvirtualsurgicalplanningandthree-dimensionalprintingguidesystemforthereconstructionofwidemaxilladefectusingthedeepcircumflexiliacarteryfreeflap.JCraniofacSurg.2019,30(6):1829-1832.CostaH,ZenhaH,SequeiraH,etal.Microsurgicalreconstructionofthemaxilla:algorithmandconcepts.JPlastReconstrAesthetSurg.2015,68(5):e89-e104.XueR,LaiQ,SunS,etal.Applicationofthree-dimensionalprintingtechnologyforimprovedorbital-maxillary-zygomaticreconstruction.JCraniofacSurg.2019,30(2):e127-e131.UrbanIA,NagurskyH,LozadaJLetal.Horizontalridgeaugmentationwithacollagenmembraneandacombinationofparticulatedautogenousboneandanorganicbovinebone-derivedmineral:aprospectivecaseseriesin25patients.IntJPeriodonticsR