改良路径行一侧上颌骨全切除后游离髂骨复合组织瓣功能性重建

Modified Approach of Full Maxillectomy and Reconstruction of the Functionality with Free Iliac Osteo-muscular Flap

目的探索改良路径一侧上颌骨全切除后游离髂骨复合组织瓣功能性重建上颌骨缺损的方法。方法采用下唇、颌下、耳前切口,应用游离带腹内斜肌的旋髂深动脉髂骨肌(皮)瓣一期重建上颌骨全切除5例,关闭口鼻腔,术后6个月后行可摘义齿修复。结果 5例组织瓣全部成活,面部外形恢复良好,重建了鼻腔、腭部、牙弓的外形,术后疤痕隐蔽。随访6～21个月,进食无食物从鼻腔返流,语音清晰。CT检查证实肿瘤未复发,张口度3.2～4.5 cm,义齿固位好,可进普食。结论经改良路径行一侧上颌骨全切除后游离髂骨复合组织瓣功能性重建上颌骨缺损,切口隐蔽、美观,有效恢复上颌骨的外形,义齿修复效果好,口腔、语言生理功能较满意。

Objective To explore the method for modified approach of full maxillectomy and reconstruction of the functionality with free iliac osteo-muscular flap.Methods There were 5 cases underwent full maxillectomy involved in this study,in which the excision line was extebded to the lower lip and the facial-chin glove.Then it went along with the mandibular margin and linked up the anterior articular parotid gland line and tilled to the same lateral hair boundary,by using deep circumflexiliac artery iliac osteo-musculocutaneous flap with obliquus internus to reconstruct full maxillectomy.Oral and nasal wounds were closed by these flaps.After 6 months they got a partial denture.Results Five cases were followed up for 6 to 21 months,all flaps were alive with satisfactory form of nasal and oral cavity and their scar were in hidden parts.They were also confirmed tumor free by CT.Their mouth opening was from 3.2 cm to 4.5 cm without nasal foods return.Five cases got a partial denture firmly and could eat normal food.Conclusion This method is not only more beauty but also had a satisfactory recovery both in facial contour and function.