颏下瓣在鼻咽癌手术修复中的应用

The application of submental flap in the nasopharyngectomy for nasopharyngeal carcinoma

目的:探索颏下瓣在鼻咽癌手术修复中的解剖要点和手术方法。方法:在5例新鲜冰冻头颅标本上进行颏下瓣的解剖学研究,重点探索颏下瓣转位至鼻颅底区的通道,分析颏下瓣所能覆盖的颅底区域。对4例复发性鼻咽恶性肿瘤患者行鼻咽癌扩大切除术并采用颏下瓣行鼻咽颅底修复。结果:解剖显示,颏下瓣经过下颌角后内侧-翼内肌后方-咽旁间隙通道可转位入鼻咽颅底,最远端可覆盖至斜坡旁段颈内动脉。临床实践显示,4例患者成功采用颏下瓣修复鼻咽颅底,随访见颏下瓣生长良好。结论:颏下瓣适用于鼻咽癌手术后的鼻咽颅底修复,值得临床推广。

Objective:To explore the anatomy and clinical application of submental flap in the nasopharyngectomy for nasopharyngeal carcinoma.Methods:The anatomical study of the submental flap was carried out on 5 cadavers,focusing on exploring the channel of the submental flap transposition to the nasopharyngeal skull base area,and analyzing the nasopharyngeal skull base area covered by the submental flap.A retrospective analysis of 4 patients with submental flap repairment after nasopharyngectomy was performed,and the surgical methods and techniques of submental flap to repair nasopharyngeal nasal skull base defect were introduced in detail.Rusults:It showed that the submental flap could be transposed into the nasopharyngeal skull base through the posteromedial of the mandible-posterior pterygoid muscle-parapharyngeal space channel,and could cover the paraclival internal carotid artery.Clinical practice showed that the submental flap was successfully used to repair the nasopharyngeal skull base defect in 4 patients,and the submental flap grew well in the follow-up.Conclusion:The submental flap is suitable for the repair of the nasopharyngeal skull base defect after nasopharyngeal carcinoma surgery,and it is worthy of clinical promotion.