面部除皱切口和胸锁乳突肌瓣转移整复术在腮腺全叶切除术中的应用

Face-lift Incision and Pedicled Sternocleidomastoid Muscle Flap Transposition Improves the Cosmetic Outcome of Total Parotidectomy

目的:探讨腮腺全叶切除术中,面部除皱切口减少面部瘢痕,胸锁乳突肌瓣修复面部凹陷的临床应用,为修复腮腺全叶切除术后的面部轮廓缺陷提供临床依据。方法:挑选53例术前初步诊断为腮腺良性病变的患者,选择腮腺全叶切除,术中采用面部除皱切口,解剖面神经并切除腮腺全叶后,以胸锁乳突肌上端为蒂部,以乳突尖下1.5～2cm处为肌瓣旋转轴点,根据缺损大小切取肌瓣,向前旋转,远端缝合至咬肌,以填充修复缺损,分层缝合腮腺咬肌筋膜、皮下组织及皮肤。结果:53例患者术后面部瘢痕不明显,左右面部基本对称,患者均对面部轮廓外形满意。结论:在腮腺全叶切除术中采用面部除皱切口有瘢痕隐蔽,不影响面部美观的临床作用;胸锁乳突肌瓣血供丰富,易于成活,切取及转移方便,为自体组织,无排异反应,是腮腺全叶切除术后修复面部轮廓外形的理想组织。

Objective：To explore the total parotidectomy,the clinical effect of the face-lift incision reduces facial scar and the sternocleidomastoid muscle flap reconstruction during the surgery to prevent facial contuor deformity.Methods：53 cases were preoperative selected as benign parotid lesions,who underwent the total parotidectomy with face-lift incision.After parotid gland was removed,we designed the pedicle of flap at the top side of sternocleidomastoid muscle.1.5-2cm lower to the mastoid tip was the pivot point for the muscle flap rotation.According to the size of deformity,we made up muscle flap,rotated forward,sutured distal muscle to the masseter muscle to fill the repair deformity.Results：The postoperative facial scar of 53 patients was not obvious.Facial symmetry were well.Patients were satisfied with appearance of facial contours.Conclusion：Parotidectomy with face-lift incision has adventage of hidden scar,and don＇t affect the facial cosmetic.The sternocleidomastoid muscle flap is easy to survive.As a self-tissue,it can be harvested and transfered conveniently.