BACKGROUND: Surgeries on maxillary sinus carcinoma, soft palate carcinoma, tonsillar cancer and other malignant tumors and surgical trauma are known to cause mandibular defects. Patients with mandibular defects usually present with chewing, swallowing and speech dysfunction and imperfect facial appearance. It is difficult to repair mandibular defects in the maxillofacial surgery.OBJECTIVE: To investigate the efficacy of fixed bite plate combined with intermaxillary traction screw in the repair of mandibular defects with free fibular flap.METHODS: Seventy-five patients with mandibular defects reconstructed using free fibular flap in the Affiliated Stomatological Medical Hospital of Southwest University of Medical Sciences from June 2014 to December 2015 were enrolled, and were than randomized to two groups: 44 patients subjected to the bite plate combined with intermaxillary traction screw served as experimental group, and the others received intermaxillary traction using dental arch splint as control group. The operation time, wound healing at donor and accepting site, the survival rate of fibular flap, facial appearance, occlusion, functional speech and complications were compared between two groups.RESULTS AND CONCLUSION: The mean operation time showed significant difference between the experimental ((9.1±1.7) hours) and control ((10.2±2.1) hours) groups (P < 0.05). There were significant differences in the facial appearance (38 vs. 20), occlusion (41 vs. 22), and functional speech (39 vs. 21) between experimental and control groups (P < 0.05). The all-complication rate and the rate of maxillofacial wound dehiscence in the experimental group were significantly lower than those in the control group (P < 0.05). These results suggest that the bite plate combined with intermaxillary traction screw is simple and effective accompanied by less complications in the repair of mandibular defects.%背景:上颌窦癌、软腭癌、扁桃体癌等恶性肿瘤手术及创伤等均可导致下颌骨缺损,下颌骨缺损患者咀嚼、吞咽、语音等功能障碍,且颜面部外观遭受影响.修复下颌骨缺损是颌面外科难题之一.目的:探讨咬合导板及颌间牵引钉技术在腓骨瓣修复下颌骨缺损中的应用价值.方法:纳入2014年6月至2015年12月在西南医科大学附属口腔医院应用游离腓骨瓣修复下颌骨缺损的患者75例,随机分为2组,试验组44例术中使用咬合导板和颌间牵引钉技术;对照组31例未采用咬合导板和颌间牵引钉技术,应用带钩牙弓夹板颌间牵引复位法.比较2组患者手术时间,供区、受区切口愈合情况,腓骨瓣成活率,面部外形,咬合关系,语音功能及并发症等多项指标.结果与结论:①试验组患者平均手术时间(9.1±1.7)h,对照组(10.2±2.1)h,2组差异有显著性意义(P<0.05);②试验组38例患者面部恢复对称,41例患者咬合关系正常/基本正常,39例患者语音功能正常/基本正常;对照组20例患者面部恢复对称,22例患者咬合关系正常/基本正常,21例患者语音功能正常/基本正常,以上差异均有显著性意义(P<0.05);③试验组患者的总并发症发生率及颌面部创口裂开率显著低于对照组(P<0.05),其余差异未见显著性意义;④结果表明,在腓骨瓣修复下颌骨缺损中应用咬合导板及颌间牵引钉技术简单有效,且并发症低.
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