重症銃撃後の顔面奇形と機能の複合的再建：1 症例報告

Complex reconstruction of facial deformity and function after severe gunshot injury: one case report.

• Weijian Wang
• Jianmin Duan
• Qiao Wang
• Wei Kuang

抄録

本報告では、重度の銃撃を受けた17歳の少年に対して、複数の手技を統合した多段階手術を行い、顔面の形態と機能を回復させた臨床結果を報告した。この多段階手術は、銃撃により顔面の大部分（唇、左鼻翼、鼻柱、鼻中隔、上顎歯槽突起、硬口蓋、軟口蓋、両側上顎骨、左頬骨、眼窩下骨欠損）を含む複雑な顔面奇形を呈した稀な1例に対して適用され、顔面の形態と機能の回復に対する臨床的効果がレトロスペクティブに評価された。この患者は、発砲による顔面欠損・変形が大きく、摂食困難、重度の咬合障害、重度の顔面欠損を呈していた。顔面形態の再建と咀嚼・咬合機能の回復のために、鏡像撮影法、ラピッドプロトタイピング法、多孔質チタンインプラント、顕微鏡手術法、歯科インプラント、筋膜フラップ、筋膜フラップ、隣接組織フラップの移動と修復、遊離骨移植による再建など、複数の検査と手術が行われました。術後、重度の顔面奇形の再建と咬合・摂食を含む基本機能の回復が初めて達成され、比較的健全な臨床成績が得られており、重度の顔面奇形の類似症例の治療に臨床的なエビデンスを付加する可能性がある。

In this report, we described clinical outcomes of a multi-stage surgery integrating multiple techniques in restoration of facial morphology and function of a 17-year-old boy with severe gunshot injuries. This multi-stage surgery was applied in treatment of one rare case of gunshot-caused complicated facial deformities involving most parts of the face (labrum, left nose wing, nasal columella, nasal septum, maxillary alveolar process, hard palate, soft palate, bilateral maxillary bones, left zygoma, suborbital bone defects) and clinical efficacy upon restoring facial form and function were retrospectively evaluated. The patient was diagnosed with massive facial defects and deformities caused by gunshot, which led to feeding difficulty, severe articulation disorders and serious facial disfigurement. To reconstruct facial form and restore functions of mastication and articulation, multiple examinations and surgical procedures including mirror imaging, rapid prototyping technique, porous titanium implants, microscopic surgical technique, dental implants, osteomyocutaneous flap, muscular flap, shifting and repairing of adjacent tissue flaps and free bone graft reconstruction were undertaken. Postoperatively, reconstruction of severe facial disfigurement and restoring basic functions including articulation and feeding for the first time and relatively sound clinical outcomes have been obtained, which may add clinical evidence to the treatment of similar cases of severe facial deformities.