下颌骨内侧牙龈处理改良法对口底瘘预防效果的观察

The effect of modified mandibular lingual gingiva removal and reconstruction on the prevention of mouth floor fistula in combined radical dissection of oral caner

目的:探讨口腔癌术中预防口底瘘下颌骨内侧牙龈处理手术方法的改进。方法:回顾性分析181例行原发灶-(颌)-颈联合根治术的口腔癌病例,所有患者均采用薄的往复锯离断下颌骨。分析离断及重建过程中牙龈、黏膜微创处理方式,并观察术后口底瘘的发生率。结果:181例病例中,皮瓣存活180例;伤口Ⅰ期愈合179例,口底感染1例,口底瘘1例。结论:在需处理下颌骨的口腔癌根治术中,通过对下颌骨内侧牙龈处理方式的改进,可减少牙龈组织的创伤,降低操作难度,完整封闭口底并有效预防术后口底瘘的发生。

Objective： To explore appropriate mandibular lingual gingiva removal and reconstruction methods to prevent mouth floor fistula. Methods： One hundred and eighty-one cases of oral cancer with combined radical dissection of carcinoma,jaw and neck were retrospectively analyzed in this study. The mandible was transected by thin reciprocating saw in all patients so as to reduce gingival impairment in the resection and reconstruction procedure. The incidence of mouth floor leakage was observed. Results： The flaps survived in 180 patients. Additionally,primary healing was observed in 179 patients while mouth floor infection happened in one patient and fistula in another one patient. Conclusion： It is modified lingual gingiva removal and reconstruction to attenuate gingival stimulation and decrease difficulties of reconstruction,in order to completely close mouth floor and effectively prevent mouth floor fistula in oral cancer patients with mandible transection.