側頭窩下欠損を生じた下顎関節包を含む下顎区域切除に即時再建を行った1例

Immediate Reconstruction for Segmental Mandibulectomy Including the Temporomandibular Joint Resulting in Infratemporal Fossa Defect

はじめに

　下顎頭を含む下顎後方欠損の再建は依然として課題が多い。下顎頭の切除を要する場合，後の顎関節強直症のリスクを低減するために関節円板の温存が推奨される 1）が，腫瘍の高度進展により関節包を含む側頭下窩の切除を要することもある。側頭下窩の組織量の減少は中顔面の形態変化を来たし，術後変形に対する再建は難渋することが多い。われわれはこのような側頭下窩欠損を生じた関節包を含む下顎区域切除に対する即時再建として，腓骨皮弁に加えて前外側大腿皮弁移植を併用することで良好な結果が得られたため報告する。

　The reconstruction of one or more defects in the posterior mandible (including the mandibular condyle) caused by advanced tumor progression remains controversial. In cases that involve extensive defects after infratemporal fossa dissection, reconstruction with a fibular flap alone cannot avoid the presence of a depressed deformity from the lateral buccal region to the temporal region. Contractures caused by soft-tissue deficiency over time are difficult to correct with two-stage reconstruction. We describe the successful results of the use of a fibular flap combined with an anterolateral thigh flap as the immediate reconstruction for a mandibular segmental resection that included the temporomandibular joint, resulting in an infratemporal fossa defect.