延长下斜方肌肌皮瓣修复下颌骨钛板外露的疗效观察

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (2): 167-171.

延长下斜方肌肌皮瓣修复下颌骨钛板外露的疗效观察

王友元¹, 张大明¹, 钟江龙¹, 范松¹, 林钊宇¹, 房思炼², 陈伟良¹

1.中山大学孙逸仙纪念医院口腔颌面外科,广东深圳 510120;
2.中山大学附属第六医院口腔颌面外科, 广东广州 510655

收稿日期:2015-01-06 出版日期:2016-03-20 发布日期:2016-04-06
通讯作者: 陈伟良,Tel: 020-81332429, Fax: 020-81332853, E-mail:drchen@vip.163.com
作者简介:王友元（1981-）,男,博士,副主任医师, E-mail:sumswangyy@163.com

Use of extended vertical lower trapezius island myocutaneous flaps to cover exposed reconstructive mandibular plates

WANG You-yuan¹, ZHANG Da-ming¹, ZHONG Jiang-long¹, FAN Song¹, LIN Zhao-yu¹, FANG Si-lian², CHEN Wei-liang¹

1.Department of Oral and Maxillofacial Surgery, Sun Yet-sen Memorial Hospital, Sun Yat-sen University. Shenzhen 510120; 2.Department of Oral and Maxillofacial Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University. Guangzhou 510655, Guangdong Province, China

Received:2015-01-06 Online:2016-03-20 Published:2016-04-06

摘要/Abstract

摘要： 目的:钛板外露是肿瘤切除后应用钛板重建下颌骨最常见的并发症,本研究对应用延长下斜方肌肌皮瓣覆盖暴露的重建钛板的疗效进行评估。方法:选取中山大学孙逸仙纪念医院口腔颌面外科收治的12例口腔癌或口咽癌下颌骨部分切除术后重建钛板外露的病例,应用延长下斜方肌肌皮瓣修复暴露的重建钛板。原发肿瘤包括下牙龈或下颌骨鳞癌5例,颊黏膜癌3例,口底癌2例,舌根癌2例;下颌骨术后缺损包括半侧下颌骨缺损1例,正中缺损2例,侧方缺损9例;重建钛板暴露方式包括口内暴露1例,口外暴露7例,口内、口外暴露4例。8例口内或口外暴露钛板应用6 cm×7 cm~6 cm×23 cm大小的延长下斜方肌肌皮瓣覆盖,4例口内、口外均暴露的钛板应用折叠下斜方肌皮瓣覆盖。结果:所有患者皮瓣存活。随访12~36个月（平均22.8个月）,1例（8.3%）患者在术后第20个月出现重建钛板外露。9例 (75.0%)患者无病生存,2例患者带瘤生存,1例（8.3%）患者在第23个月因肿瘤转移而死亡。结论:延长下斜方肌肌皮瓣修复口内、口外或口内、外钛板外露是一种可靠的方法。

关键词: 口腔癌, 斜方肌皮瓣, 下颌骨缺损, 重建钛板

Abstract: PURPOSE: Plate exposure was the most common complication following reconstruction after oncological resection using a titanium plate, we evaluated the outcomes of covering exposed reconstructive mandibular plates with extended vertical lower trapezius island myocutaneous flaps (TIMFs) in the present study. METHODS: Twelve patients with exposure of reconstructive plates were treated following segmental mandibulectomy due to cancer of the oral cavity and oropharynx. We covered the plates with extended vertical lower TIMFs. The primary site of tumor was located in gingiva/mandible in 5 cases, buccal mucosa in 3 cases, the floor of the mouth in 2 cases, and the base of the tongue in 2 cases. The types of bone defect were hemi-mandible in 1 case, central defect in 2 cases, and lateral defect in 9 cases. Intraoral, extraoral, and intra-extraoral exposure occurred in 1, 7 and 4 cases, respectively. Intraorally and extraorally exposed plates were re-covered with skin paddles measuring 6 cm×7 cm to 6 cm×23 cm (average, 6.0 cm×13.5 cm). Four folded extended vertical lower TIMFs were used to cover the plates exhibiting intra-extraoral exposure. RESULTS: All flaps survived. Patients were followed-up for 12-36 months (mean time 22.8 months). One patient (8.3%) exhibited external plate exposure at 20 months. Nine patients (75.0%) were alive with no evidence of disease at 12-36 months and two (16.7%) were alive with disease at 20-28 months. One patient (8.3%) died of local recurrence at 23 months. CONCLUSIONS: The use of extended vertical lower TIMFs to cover intraorally, extraorally, or intra-extraorally exposed plates is reliable.

Key words: Oral cancer, Trapezius flap, Mandibular defects, Titanium plate

中图分类号:

R782.2

王友元, 张大明, 钟江龙, 范松, 林钊宇, 房思炼, 陈伟良. 延长下斜方肌肌皮瓣修复下颌骨钛板外露的疗效观察[J]. 中国口腔颌面外科杂志, 2016, 14(2): 167-171.

WANG You-yuan, ZHANG Da-ming, ZHONG Jiang-long, FAN Song, LIN Zhao-yu, FANG Si-lian, CHEN Wei-liang. Use of extended vertical lower trapezius island myocutaneous flaps to cover exposed reconstructive mandibular plates[J]. China J Oral Maxillofac Surg, 2016, 14(2): 167-171.

参考文献

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