改良颞肌瓣对上颌骨切除后眶底合并硬腭缺损的I期修复疗效

Simultaneous repairing defects of orbital floor and palate with the modified temporalis muscle flap after the maxillectomy

目的探讨改良颞肌组织瓣对不能用游离瓣修复的全上颌骨切除术后眶底合并硬腭同时缺损的Ⅰ期修复及其疗效。方法回顾性分析2008年6月至2014年6月，首都医科大学附属北京同仁医院耳鼻咽喉头颈外科收治的15例上颌骨区恶性肿瘤术后患者的病历资料，从外形恢复、口腔及眼功能方面观察改良颞肌对合并眶底壁和硬腭缺损的疗效。结果全部15例患者随访12-81个月，改良颞肌瓣均未发生坏死，其中3例患者术前放疗，12例术后放疗。4-6周颞肌瓣上皮化完成，所有患者均吞咽、语言功能良好。外鼻无继发性畸形发生。所有患者眼位正常，且未出现患眼复视、视力下降和视力丧失。结论对于不能用游离组织瓣修复的患者，改良颞肌瓣在全上颌骨切除术后遗留的眶底壁及硬腭缺损的Ⅰ期修复可以获得满意的功能效果。

ObjectiveTo evaluate the outcome of one-stage reconstruction of maxillary and orbital defects with modified temporalis muscle flap （TMF） following the removal of malignant neoplasms. MethodsIn this retrospective study, 15 patients underwent the reconstruction of defects of orbital floor and palate after maxillectomy for malignant tumor were included from June 2008 to June 2014. The modified temporalis muscle flap was used to repair the defects after surgery, and functional outcomes were analyzed. ResultsAll the patients were followed up for 12-81 months. Three cases of them received preoperative radiotherapy and 12 cases underwent postoperative radiotherapy. All flaps were survived. Epithelization of the tissues in oral and nasal cavity was completed in 4-6 weeks. Good functional reconstruction on swallowing and speaking functional results were achieved with maxillary and orbital reconstruction and no secondary deformity of external nose was observed. The eye positions in all cases were normal. Diplopia, diminution and loss of vision were not found. ConclusionThe modified TMF can be used for simultaneous reconstruction for the defects of orbital floor and palate after maxillectomy in patients whom free tissue flap can not be applied to, showing better cosmetic and functional results.