颊脂肪垫瓣在修复口腔颌面部缺损中的应用

Application of buccal fat pad flap in repair of oral-maxillofacial defects

目的探讨颊脂肪垫瓣在修复口腔颌面部缺损的应用和效果.方法将颊脂肪垫形成一蒂在后方的颊脂肪垫组织瓣转移至缺损区,在无张力下与创缘缝合,表面轻轻用碘仿纱布缝线包压法固定.用以修复口腔颌面部的良恶性肿瘤手术或损伤留下的缺损以及口腔上颌窦瘘共18例.其中修复腭部缺损2例,上颌骨切除后缺损7例,颊黏膜癌切除后缺损3例,颊部良性肿瘤切除后缺损4例,磨牙后区黏表癌切除后缺损1例,封闭拔牙后口腔上颌窦瘘1例.结果术后10 d去除碘仿纱布,见颊脂肪垫轻度水肿,2～4周后水肿明显消退,颊脂肪垫表面逐渐上皮化,6～8周内表面完全上皮化,3个月后再生黏膜与正常口腔黏膜相似.全部病例效果满意,无感染、坏死等并发症发生.结论带蒂颊脂肪垫瓣修复口腔颌面部缺损,方法简单、易行,效果满意,值得推广.

Objective To explore the use of buccal fat pad flap in the defect repair of oral-maxillofacial regions, and its surgical technique, indication, advantage, disadvantage, and complications. Methods The buccal fat pad flap was made into a tissue flap which blood supply came in the rear. The flap was transfered to the defect and sutured at the cut edge without tension. At last, the flap was bound and pressured using iodoform gauze lightly. The flaps were applied to reconstruct the defects of benign and malignant tumors in oral-maxillofacial regions, injury and oral maxillary sinus fistula. All the 18 cases included 2 cases of palate defects, 7 cases of defects after maxillas were removed, 3 cases of defects after buccal mucosa carcinomas and 4 cases of defects after buccal benign tumors were removed, 1 case of defect after mucoepidermoid carcinoma behind molar was cut off, and 1 case of defect of oral maxillary sinus fistula after extraction of tooth. Results Iodoform gauze was removed 10 days after operation, when buccal fat pad flap was a little dropsical. The edema disappeared mostly after 2-4 weeks and the surface of buccal fat pad flap epithelialized little by little and epithelialized completely within 6-8 weeks. After 3 months, the regenerated mucosa was alike the normal oral mucosa. Adequate closure of the defects achieved during surgery in all cases. All the flaps survived completely and no operative complications occurred. Conclusions The buccal fat pad as a flap offers an adequate reconstruction in oral-maxillofacial region defects. It is a simple and quick surgical technique and is worthy to be recommended.