T-CHSA 020-2023 上頜骨缺損手術(shù)功能修復(fù)重建的專家共識(shí)

學(xué)兔兔標(biāo)準(zhǔn)下載ICS11.060.01CCS

C05中華口腔醫(yī)學(xué)會(huì)團(tuán) 體 標(biāo) 準(zhǔn)T/CHSA020—2023上頜骨缺損手術(shù)功能修復(fù)重建的專家共識(shí)Expertconsensusstatementonsurgicalreconstructionprincipleformandibulardefect2023-05-19發(fā)布 2023-06-01實(shí)施中華口醫(yī)學(xué)會(huì) 發(fā)布T/CHSA020T/CHSA020—2023學(xué)兔兔標(biāo)準(zhǔn)下載目 次前言 III引言 IV112范引文件 13語(yǔ)定義 14應(yīng)與忌證 1適1禁15前2上骨損區(qū)2損圍床2像檢查 25.1.3內(nèi)2供的26建機(jī)選擇 2一骨2二骨27作2數(shù)化據(jù)集擬外設(shè)計(jì) 2血化移重頜骨損供選擇 3上骨塑要點(diǎn) 3軟織聯(lián)穿植修上骨3贗治療 38頜重術(shù)的修復(fù) 4義修前4組誘成4庭成4常義修方式 4摘齒塞4植支式定義修復(fù) 49見(jiàn)發(fā)預(yù)與4受并4供并5參考獻(xiàn) 6II前 言本文件按照GB/T1.1—2020《標(biāo)準(zhǔn)化工作導(dǎo)則第1部分：標(biāo)準(zhǔn)化文件的結(jié)構(gòu)和起草規(guī)則》的規(guī)定起草。本文件由中華口腔醫(yī)學(xué)會(huì)口腔修復(fù)學(xué)專業(yè)委員會(huì)提出。本文件由中華口腔醫(yī)學(xué)會(huì)歸口。III引 言2020年1/32-3IV上頜骨缺損手術(shù)功能修復(fù)重建的專家共識(shí)范圍本文件沒(méi)有規(guī)范性引用文件。下列術(shù)語(yǔ)和定義適用于本文件。上頜骨缺損maxillarydefects1/3JamesBrown[1-4]血管化骨移植vascularizedbonegrafting（肌穿顴種植聯(lián)合軟組織皮瓣zygomaticimplantationcombinedwithsofttissueflap，ZIP[5]頜面贗復(fù)體maxillofacialprosthesis適應(yīng)證禁忌證1[7]對(duì)上頜骨重建的患者推薦進(jìn)行頜面部螺旋CT掃描和全景片拍攝，如需數(shù)字化設(shè)計(jì)則需要層厚在1mm以下的CT掃描。CTCT（1mm）1/3[8]部分腫瘤患者局部或全身不具備條件即刻修復(fù)上頜骨缺損，還有部分長(zhǎng)期佩戴贗復(fù)體修復(fù)效果不數(shù)字化治療方案規(guī)劃的主要內(nèi)容包括:2結(jié)合擬修復(fù)的頜骨外形輪廓與種植體位置角度對(duì)參照鏡像翻轉(zhuǎn)健側(cè)頜骨模型；越過(guò)中線的缺3D手術(shù)輔助導(dǎo)板與手術(shù)導(dǎo)航是將虛擬設(shè)計(jì)準(zhǔn)確轉(zhuǎn)化到實(shí)際手術(shù)中的不同方式，可以根據(jù)實(shí)際情25cm9-10cm優(yōu)勢(shì)在于可攜帶組織量充足的軟組織皮島，可以修復(fù)伴有大面積皮膚或復(fù)合組織缺損的上頜骨缺損病由于上頜骨的特殊形態(tài)，移植骨必須經(jīng)過(guò)塑形才能與之匹配，主要要點(diǎn)為：（JamesBrownI-II7-10（7-1033上頜骨重建患者牙槽嵴表面常有皮瓣或松軟肥厚的軟組織覆蓋，不利于維持健康的種植體周?chē)M植入7.1.1[11,12][13,14]1cmCBCT[15]3（）17,18］。4[18]5參 考 文 獻(xiàn).:[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