上颌骨成形术

MAXILLOPLASTY: WITH A REPORT OF 37 CASES

目的:探讨上颌骨大块组织切除后同期行上颌骨成形的可行性。方法:①重建上颌骨底壁:采用带蒂鼻中隔向下翻折与颊瓣相吻合;或利用残存的硬腭黏骨膜瓣与颊瓣相吻合;②重建上颌骨上壁:用带蒂鼻中隔向上翻折与眶下外侧缘固定;③重建上颌骨前壁:术中先带蒂翻揭上颌窦前壁骨片,术毕复回原位固定。结果:恶性肿瘤34例中,3年生存率为67.6%(23/34),5年生存率为35.3%(12/34)。良性肿瘤3例术后5-8年未见复发。重建上颌骨底壁29例, 术后吞咽、发声功能良好。重建上颌骨顶壁5例,术后患者眼球无下陷、无复视。重建上颌骨前壁3例术后面颊部无明显凹陷畸形,深呼吸时面颊皮肤无波动感。结论:上颌骨大块切除时同期行上颌骨成形术符合生理要求,延长了患者生命, 提高了生存质量。

Objective: To evaluate the method of maxilloplasty simultaneously after maxillectomy to improve the quality of life. Method:(1) Reconstrucion of the basis wall of the maxilla: anatomosed the nasal septum turned downward with pedunculus with the cheek flap; or anastomosed the residual mucoperiostum of hard palte with the cheek flap. (2) Reconstruction of the roof wall of the maxilla: fixed the nasal septum turned upwards with pedunculus to the inferolateral rim of orbit. (3) Reconstruction of the anterior wall of the maxilla: overturned the bone of the anterior wall of maxillary sinus with pedunculus firstly and reduced after the operation.Results: Of the 34 cases of malignant tumors, three years survival rate was 67.6% (23/24), five years' survivial rate was 35.3% (12/34) .3 cases with benign tumors did not relapse 5-8 years after the operation.Twenty-nine cases received reconstruction of the basis wall of the maxilla had good function of swallowing and phonation. Five cases of reconstruction of the roof wall of the maxilla had no sunken eyes and diplopia.There were not remarkable sunked deformity of the faciobucca and no fluctuation of faciobucca when deep breathing in the three cases of reconstruction of the anterior wall of the maxilla.Conclusion: The maxilloplasty simultaneously after maxillectomy can no: only lengthen the life but also improve the quality of life.