带蒂颊脂垫衬里骨移植重建上颌骨的应用研究

Immediate maxillary reconstruction after tumor excision by using lined buccal-fat-pad flap with bone graft technique

目的 寻找解决上颌骨轮廓重建时 ,因移植物常暴露在上颌窦腔和鼻腔 ,移植骨吸收和死骨形成发生率高而导致重建失败的方法。方法 在尸体解剖、活体观察及动物实验的基础上对颊脂垫组织作了研究 ;1988年以来采用带蒂颊脂垫衬里骨移植一期重建上颌骨形态和功能 38例。结果 该组织瓣的解剖恒定 ,血供丰富 ,易于切取 ,供区与受区邻近 ,上颌骨轮廓的重建与肿瘤切除术可同时进行 ,并可在同一切口内完成手术。全部病例面部轮廓对称 ,张口正常 ,语言清晰 ,3例手术后发生瘘管 ,创口二期愈合 ,其余病例创口一期愈合 ,无移植骨吸收和死骨形成等并发症。结论 带蒂颊脂垫衬里骨移植一期重建上颌骨形态和功能 ,将带蒂颊脂垫植入上颌窦与移植骨之间 ,避免了移植物的暴露 ,血管化的颊脂垫不仅有助于移植骨较好的结合 ,同时能恢复上颌窦的正常生理功能。

ObjectiveTo evaluate the role of buccal-fat-pad flap in the lined coverage of the maxillary bone graft for the maxillary reconstruction after the tumor excision. Methods Based on the cadaver anatomical observation of the buccal-fat-pad, 38 patients with the maxillary tumors were undertaking the treatment in this paper. Under general anesthesia, the buccal-fat-pad flap was elevated and transferred to the anterior or nasal cavities as a line of the sinus after the tumor was immediately excised through an intro-oral or external approach. The bone from the ribs was then grafted in the place for the maxillary support. Results After the anatomical evaluation, 38 patients were carried out the operation successfully. All of the grafted bones were well covered without bone exposure. The aesthetic appearance was achieved. Conclusion Bone graft lined by the pedicled buccal fat pad flap may be a safe and good method for reconstruction of the maxilla with a lower rate of re-absorption and sequestration.