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안면부 총상으로 인한 하악골 정중부 결손환자의 장골이식 치험례
김명진(Myung Jin Kim),김민형(Min Hyung Kim),정인원(Jn Won Jung),김판식(Pan Sik Kim),진우정(Woo Jung Jin) 대한구강악안면외과학회 1982 대한구강악안면외과학회지 Vol.8 No.1
Early planning of overall treatment is important for patients with avulsion defects of mandible as a result of fireann injuries. Bone grafting procedure may be necessary for restoration of mandibular continuity, contour, and function. Autogenous bone has been considered the best bone grafting material, but one should, first of all, consider the general principles and mechanisms of bone grafting. The authors have experienced the complicated case of free iliac bone graft for the mandibular symphysis discontinuity defect, which caused by gun shot wound. Many problems have occured during intermediate and reconstructive phases such as mandibular medial contraction, postoperative infection, graft bone resorption, and improper restoration of masticatory function, etc.. The results are as follows: 1. Successful bone grafting of the mandibular symphysis area is the most difficult to accomplish, due to adverse influences such as aversion and rotation forces, soft tissue tension, and diminished vascularity of the graft region, etc.. 2. Treatment must be predicted on through examination, early organized planning, and continuing evaluation of patients status through the various stages of treatment. 3. In cases of mandibular symphysis defect, it is important to maintain the remaining proximal fragments in their proper position and alignment to prevent mandibular medial migration. 4. The bone graft should performed under asepsis and should do adequate antibiotics coverage. 5. The osteogenic capacity of the periosteum in bone graft procedure is considered very important. 6. The solid free iliac bone should be decorticated and that is brought in close contact with a highly vascular connective tissue and must remain in intimate contact with this soft tissue for adequate blood supply.
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