经口半上颌骨切除术：一种用于广泛上颌骨纤维性结构不良切除及即刻游离皮瓣重建的无瘢痕入路

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中文摘要

上颌骨切除术传统上需要Weber-Ferguson经面切口，会遗留永久性面部瘢痕。我们描述了一例纯经口半上颌骨切除术，患者为28岁男性，患有左侧上颌骨广泛纤维性结构不良，此前在别处接受过3次保守治疗后复发，并逐渐压迫眶部。仅通过龈唇沟前庭和腭黏膜切口整块切除半上颌骨，无任何面部切口，也无内镜辅助；使用Walsham钳向下折断将标本送入口腔。同期以游离腹直肌肌瓣消灭死腔。皮瓣完全成活，1年临床和影像学随访显示无复发、面部对称性恢复且无面部瘢痕。至7个月时，上颌牙弓已用可摘局部义齿修复，患者佩戴舒适并可不受限制地进食。自那以后11年间患者未因复发疾病就诊。

英文摘要

Maxillectomy conventionally requires a Weber-Ferguson transfacial incision, which leaves a permanent facial scar. We describe a purely transoral hemimaxillectomy in a 28-year-old man with extensive fibrous dysplasia of the left maxilla that had recurred after 3 conservative procedures elsewhere and was progressively narrowing the orbit. The hemimaxilla was removed en bloc through gingivolabial vestibular and palatal mucosal incisions alone, without any facial incision and without endoscopic assistance; down-fracture with Walsham forceps delivered the specimen into the mouth. The dead space was obliterated in the same session with a free rectus abdominis muscle flap. The flap survived completely, and 1 year of clinical and radiologic follow-up showed no recurrence, restored facial symmetry, and no facial scar. By 7 months, the maxillary arch had been restored with a removable partial denture that was worn comfortably on an unrestricted diet. The patient has not returned with recurrent disease in the 11 years since.