弹性唇红瓣在口颊癌术后口角重建中的应用

Application of orbicularis oris elastic musculomucosal flap in reconstruction of modiolus after resection of buccal-mucosal squamous cell carcinoma

目的探讨口角缺损的修复重建方法。方法收集2014年12月~2015年8月诊治的23例口颊癌并累及口角的患者,年龄为45~67岁,平均年龄为54.4岁,其中左侧口颊癌12例,右侧口颊癌11例,病理类型均为鳞癌,临床分期为III-IV期。将肿瘤病灶切除后,根据缺损范围,设计切取游离一蒂双瓣的股前外侧游离皮瓣或者前臂皮瓣折叠分别修复面颊、口颊内黏膜缺损创面。设计上、下唇红黏膜瓣,沿上、下红唇黏膜缘全层切开,制备成弹性唇红瓣,滑行推进修复重建口角,将面颊、口颊黏膜侧的皮瓣与唇瓣缝合。结果所有患者术后口角闭合功能恢复可,双侧口角基本对称,红唇黏膜连续性可,患者对唇部外形满意。结论弹性唇红瓣以上唇、下唇动脉为血管蒂,具有良好的血运,同时包含部分口轮匝肌,不但能重建口轮匝肌的完整性,并获得较好的外形,是一种安全、可靠的口角修复重建方法。

Objective To explore surgical reconstruction of the modiolus. Methods 23 cases suffering from buccal-mucosal squamous cell carcinomas were operated upon between Dec 2014 and Oct 2015. Reconstruction of cheek and oral commissure in one-stage surgery with either anterolateral thigh flap or free radial forearm flap was performed. The orbicularis oris elastic musculomucosal flaps were adopted for the reconstruction. The patients＇ age ranged from 45 to 67 years old with an average of 54. 4. Results The modiolus reconstruction attained satisfactory functional and cosmetic results. The bilateral oral commisures were symmetry. Conclusions With good blood supply from vascular pedicle consisted of superior and inferior labial arteries,orbicularis oris elastic musculomucosal flap contains orbicularis oris muscle and can reestablish the function of orbicularis oris muscle ring. This flap is safe and reliable for modiolus reconstruction.