钛网支架结合前臂游离皮瓣修复上颌部缺损:可更好地维护吞咽和语言功能

Titanium mesh combined with forearm free flap for maxillary defects is better to maintain swallowing and language function

背景:以往在临床上颌部修复过程中大多采用赝体修复方式,该修复方式虽然可在一定程度上维护患者的吞咽功能和语言功能,但如果缺损过大,赝复体固位差,极易出现各种不良后果。目的:探讨钛网支架结合前臂游离皮瓣修复上颌部缺损,维护患者吞咽和语言功能的效果。方法:纳入35例上颌部缺损患者,其中男19例,女16例,年龄33-63岁,其中17例切除上颌骨并利用碘仿油纱条进行局部创面填塞,术后1年采用中空式赝复体修复,作为对照组;另18例采用钛网支架结合前臂游离皮瓣修复,作为观察组。修复后随访24个月,利用生存质量功能量表评估语言、吞咽等功能。结果与结论:修复后24个月,患者对面部外形修复效果均表示满意,未发生与修复材料相关的不良反应,观察组的吞咽功能、语言功能、疼痛功能、面容功能、行动功能、娱乐功能、咀嚼功能及口腔卫生得分均显著高于对照组(P<0.05),肩部功能障碍评分显著低于对照组(P<0.05),显示观察组修复后的生活质量显著高于对照组。表明采用钛网支架结合前臂游离皮瓣修复上颌部缺损可以更好地维护患者的吞咽和语言功能。

BACKGROUND：Prosthetic appliance is often adopted for clinical maxilary repair, which can maintain swalowing and language function in patients with a certain extent, but if the defect is too large, the prosthesis has a poor fixed effect that is prone to inducing various adverse consequences. OBJECTIVE：To explore the maintenance effect of titanium mesh combined with forearm free flap on swalowing and language function in patients with maxilary defects. METHODS：A total of 35 patients with maxilary defects, 19 males and 16 females, aged 33-93 years, were enroled. Among them, 17 patients underwent maxilectomy and wound packing with iodoform gauzes, and then after 1 year, these patients were given prosthesis repair as control group; another 18 patients were subjected to titanium mesh combined with forearm free flap for repair of maxilary defects as observation group. Al the patients were folowed up for 24 months, and the swalowing and language functions were evaluated. RESULTS AND CONCLUSION：At 24 months after repair, al the patients were satisfied with facial appearance, and there were no adverse reactions related to repair materials. Scores on swalowing function, language function, pain fucntion, face function, motor function, entertainment function, masticatory function and oral health were significantly higher in the observation group than the control group （P 〈 0.05）, and the score on the shoulder dysfunction was lower in the observation than the control group, indicating the patients in the observation group had a higher quality of life than those in the control group. These findings indicate that titanium mesh combine with forearm free flap for maxilary defect repair can be better to maintain the swalowing and language function of patients.