Journal of Prevention and Treatment for Stomatological Diseases ›› 2021, Vol. 29 ›› Issue (11): 766-770.doi: 10.12016/j.issn.2096-1456.2021.11.007

• Clinical Study • Previous Articles     Next Articles

Application of digital surgery in the reconstruction of mandibular composite defects with chimeric deep circumflex iliac artery perforator flap

TANG Jianming(),XIE Hongliang,LU Lu,LI Bohan,LIU Haonan,ZHANG Guoquan   

  1. Department of Stomatology, Shenzhen People’s Hospital, Shenzhen 518020, China
  • Received:2021-02-22 Revised:2021-05-02 Online:2021-11-20 Published:2021-07-20
  • Contact: Jianming TANG E-mail:18801558@qq.com

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Abstract:

Objective The purpose of this study was to explore the application value of digital surgery in the reconstruction of mandibular composite defects with a chimeric deep circumflex iliac artery perforator flap (DCIAPF). Methods Six patients with complex defects within half of the mandible underwent reconstruction using DCIAPF from January 2019 to January 2020 in Shenzhen People’s Hospital. Doppler was used to locate the deep iliac circumflex artery, the range of mandibular osteotomy was designed, and DCIAPF was used to repair the mandibular composite under the guidance of the guide plate during the operation. Twelve months postoperatively, the facial shape, jaw height, and occlusal relationship were evaluated.Results DCIAPF was harvested successfully in 6 patients, and the heights of all alveolar ridges and occlusal function of patients were significantly restored, without pain or snapping in the temporomandibular joint area. Conclusion The blood supply of DCIAPF is rich, and soft-bone tissue is sufficient for the reconstruction of mandibular composite defects. Combined with digital surgery, the accuracy and safety are improved.

Key words: digital surgery, deep circumflex iliac artery, perforator flap, chimeric flap, mandibular defect, reconstruction, precision medicine

CLC Number: 

  • R78

Table 1

Clinical characteristics of the patients"

Case Gender Age（years） Diagnosis The extent of the complex defect of the mandible Characters of DCIAPF
Soft tissue Bone Size of iliac bone（cm） Size of skin paddle（cm）
1 Male 56 GSCC Buccal B 6.0 × 3.0 4.0 × 8.0
2 Male 43 GSCC Buccal B 5.0 × 2.5 3.0 × 4.0
3 Male 50 GSCC Buccal BSH 9.0 × 3.0 5.5 × 8.5
4 Male 40 GSCC FOM BSH 10.5 × 3.0 6.5 × 9.0
5 Male 35 Ameloblastoma Buccal B 7.5 × 2.5 4.0 × 6.0
6 Female 35 GSCC Buc BSH 7.5 × 3.0 5.5 × 8.0

Table 2

Postoperative clinical characteristics of the patients at 12 months"

Case Height of mandibular（cm） Opening
degree （cm） 		TMD Recurrence
Intact side Affected side
1 3.1 2.7 2.5 N N
2 2.9 2.3 2.6 N N
3 3.0 2.6 2.6 N N
4 3.0 2.8 2.7 N N
5 2.8 2.3 3.2 N N
6 3.1 2.8 3.2 N N

Figure 1

Digital surgery in the reconstruction of mandibular composite defects with chimeric deep circumflex iliac artery perforator flaps a: preoperative intraoral photograph; b: the osteotomy range was designed before the operation;c: osteotomy guide for mandible and ilium; d&e: the models for 3D printing; f: the skin perforation point of the deep iliac circumflex artery was located and the size of the skin island was designed; DCIAPF was completed; g: reconstruction of the composite mandibular defect; h: appearance of the intraoral flap at 12 months after operation; DCIAPF: chimeric deep circumflex iliac artery perforator flaps"

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