Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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FUNCTIONAL RECONSTRUCTION OF DENTO-PALATAL AND MAXILLARY DEFECT USING STAGED OPERATION OF PREFABRICATED SCAPULAR FREE FLAP AND DENTAL IMPLANTS

분층피부와 분말골로 이식 전 처리된 유리견갑골근피판과 임플란트 보철을 이용한 경구개와 상악골의 기능적 재건

  • Lee, Jong-Ho (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Seoul National University) ;
  • Kim, Myung-Jin (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Seoul National University) ;
  • Park, Jong-Chul (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Seoul National University) ;
  • Kim, Yung-Soo (Dept. of Prosthodontics, College of Dentistry, Seoul National University) ;
  • Ahn, Kang-Min (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Seoul National University) ;
  • Paeng, Jun-Young (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Seoul National University) ;
  • Kim, Sung-Min (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Kangnung National University) ;
  • Myoung, Hoon (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Seoul National University) ;
  • Hwang, Soon-Jung (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Seoul National University) ;
  • Seo, Byoung-Moo (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Seoul National University) ;
  • Choi, Jin-Young (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Seoul National University) ;
  • Choung, Pill-Hoon (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Seoul National University)
  • 이종호 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 김명진 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 박종철 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 김영수 (서울대학교 치과대학 치과보철학교실) ;
  • 안강민 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 팽준영 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 김성민 (강릉대학교 치과대학 구강악안면외과학교실) ;
  • 명훈 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 황순정 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 서병무 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 최진영 (서울대학교 치과대학 구강악안면외과학교실) ;
  • 정필훈 (서울대학교 치과대학 구강악안면외과학교실)
  • Published : 2004.08.31
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Abstract

The flap considered at first for the reconstruction of large maxillary defect, especially mid-face defect, is scapular free flap, because it provides ample composite tissue which can be designed 3-dimensionally for orbital, facial and oral reconstruction. In case of maxillary defect involving hard palate, however, this flap has some limitations. First, its bulk prevents oral function and physio-anatomic reconstruction of nasal and oral cavity. Second, mobility and thickness of cutaneous paddle covering the alveolar area reduce retention of tissue-supported denture and give rise to peri-implantitis when implant is installed. Third, lateral border of scapula that is to reconstruct maxillary arch and hold implants is straight, not U-shaped maxillary arch form. To overcome these problems, new concept of step prefabrication technique was provided to a 27-year-old male patient who had been suffering from a complete hard palate and maxillary alveolar ridge defect. In the first stage, scapular osteomuscular flap was elevated, tailored to fit the maxillary defect, particulated autologous bone was placed subperiosteally to simulate U-shaped alveolar process, and then wrapped up with split thickness skin graft(STSG, 0.3mm thickness). Two months later, thus prefabricated new flap was elevated and microtransferred to the palato-maxillary defect. After 6 months, 10 implant fixtures were installed along the reconstructed maxillary alveolus, with following final prosthetic rehabilitation. The procedure was very successful and patient is enjoying normal rigid diet and speech.

Keywords

References

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