单段腓骨肌皮瓣在修复Ⅱ型上颌骨缺损中的应用

目的 探讨通过改良口角颌下切口入路及应用单段腓骨肌瓣修复上颌骨次全切除术后Ⅱ型缺损的临床疗效.方法 对11例应用单段腓骨肌瓣修复上颌骨次全切除术后Ⅱ型缺损的患者进行回顾性分析.结果 所有患者切口愈合良好,咬合关系、张口、发音正常,无复视、眼睑外翻、面瘫及下唇感觉麻木等并发症发生.结论 通过改良口角颌下切口入路,应用单段腓骨肌瓣修复上颌骨次全切除后Ⅱ型缺损,该切口美观,术后效果好.     

下唇-颏唇沟-颌下径路在上颌骨次全切除术中的应用

目的：探讨下唇-颏唇沟-颌下径路在上颌骨次全切除术中的应用价值。方法：采用下唇-颏唇沟-颌下径路对11例上颌部肿瘤患者施行上颌骨次全切除术，术中遗留缺损用前臂皮瓣与钛网联合修复。结果：该术式术野显露良好，随访6个月～2年，所有病例均无下睑水肿、睑外翻和泪溢；仅3例出现暂时性口角歪斜，3个月后均恢复正常；无肿瘤复发，移植皮瓣全部成活，牙槽突和腭部形态恢复良好，面部外形恢复良好，张口无受限。结论：下唇-颏唇沟-颌下径路用于上颌骨次全切除术，符合肿瘤外科、美容外科和功能性外科原则。     

上颌骨全切除术改良的手术径路

目的　根据上颌骨解剖学上的特点 ,结合各类手术径路的优点 ,设计一种改良的上颌骨全切除术的手术径路 ,旨在改善术后的外形与功能。方法　共有 17例患者采用了该上颌全切除术的手术径路 ,即 :切口设计在下唇 ,沿颏面沟与颌下、腮腺耳前切口连接至同侧发际。切口设计依据为避开上颌区 ,隐蔽切口位于面颌部正常的皮肤皱折区 ,术中对面神经下颌缘支、下颊支、颏神经、腮腺导管以及内眦部等均加以保存。其中行上颌骨全切除 14例 ,次全切除 3例。结果　经 1～ 12个月术后随访 ,疗效满意。其中 11例术后放疗患者均未出现任何皮肤坏死及下颌水肿。因保存了面神经下颌缘支和下唇肌支 ,仅 1例发生轻度口角歪斜畸形。结论　本文提出的上颌骨全切除术改良的径路 ,能充分暴露并完整切除上颌骨肿瘤 ,术后有较满意的外形及功能 ,可作为上颌骨全切除的一种常规手术径路。若病变超过上颌骨区的范围 ,则不应采用本文介绍的手术径路     

改良下唇切口进路切除口腔恶性肿瘤

目的 :设计一种改良下唇切口的手术径路,便于口腔内深部肿瘤的暴露和切除,改善术后面部的外形与功能。方法:15例口腔恶性肿瘤患者,采用改良下唇切口的手术径路:经口角附近沿颏面沟自然弧度向下与颈淋巴清扫颌下切口连接,切口线隐蔽于颏面沟皮肤皱折区。结果:经口角旁下唇切口较下唇正中切口短,对组织结构损伤相对减小,病灶暴露更加充分,操作更加便捷。经术后1年以上随访,疤痕隐蔽、唇红缘无凹陷、颏部外形圆润,无口角歪斜等面瘫症状。结论:采用改良下唇切口进路切除口腔恶性肿瘤能充分暴露并完整切除肿瘤,且术后有较满意的外形及功能,可作为口腔内深在肿瘤切除的常规手术径路。     

下唇-颏唇沟-颌下径路在腭后部肿瘤切除术中的应用

目的探讨下唇-颏唇沟-颌下径路在腭后部肿瘤切除术中的应用价值。方法采用下唇-颏唇沟-颌下径路对6例腭后部肿瘤患者施行肿瘤扩大切除术,遗留缺损用游离前臂皮瓣移植修复。结果术野显露良好,随访3个月～3年,仅1例患者出现暂时性口角歪斜,3个月后恢复正常;无肿瘤复发,移植皮瓣全部成活,腭部形态和面部外形恢复良好,张口无受限。结论下唇-颏唇沟-颌下径路用于腭后部肿瘤扩大切除术,术野显露良好,符合肿瘤外科、美容外科和功能性外科原则。     

应用改良径路行上颌骨切除术4例

上颌骨切除术是治疗上颌骨肿瘤的主要手术,一般采用传统的Weber-Fengusson入路.Weber-Fengusson切口术野较好,可完整地切除上颌骨,但是术后为患者遗留有下睑、鼻侧以及上唇部疤痕,影响美观及功能.自2002年5月至2004年3月,我科对4例侵犯上颌骨的肿瘤,采用改良后的径路行上颌骨切除术,术后疗效满意,现介绍如下.     

面颊外翻颌咽联合入路切除咽旁间隙巨大肿瘤

目的：介绍一种新的切除咽旁间隙巨大肿瘤的手术入路,探讨其可行性和安全性。方法：2005年1月—2009年6月,对9例咽旁间隙巨大肿瘤,采用面颊外翻颌咽联合入路进行手术。取下唇外侧及下颌下切口,在颈阔肌和表情肌浅面游离皮瓣并向外侧掀起,沿咬合线切开面颊肌,继而向后切开磨牙后区及咽侧壁黏膜,从口内及下颌下2个方向充分显露瘤体,完整切除肿瘤。结果：9例患者均顺利完成手术,术中观察到此入路术野大、显露充分,可以完整切除肿瘤,并且利于彻底止血。术后未发生面神经麻痹和术腔感染。结论：面颊外翻颌咽联合入路将口内外切口进行有效地结合,术野清楚,尤其口内切口显露充分,适合咽旁间隙巨大肿瘤的切除,特别是向颊部侵犯的肿瘤。     

改良路径行一侧上颌骨全切除后游离髂骨复合组织瓣功能性重建

目的探索改良路径一侧上颌骨全切除后游离髂骨复合组织瓣功能性重建上颌骨缺损的方法。方法采用下唇、颌下、耳前切口,应用游离带腹内斜肌的旋髂深动脉髂骨肌（皮）瓣一期重建上颌骨全切除5例,关闭口鼻腔,术后6个月后行可摘义齿修复。结果 5例组织瓣全部成活,面部外形恢复良好,重建了鼻腔、腭部、牙弓的外形,术后疤痕隐蔽。随访6～21个月,进食无食物从鼻腔返流,语音清晰。CT检查证实肿瘤未复发,张口度3.2～4.5 cm,义齿固位好,可进普食。结论经改良路径行一侧上颌骨全切除后游离髂骨复合组织瓣功能性重建上颌骨缺损,切口隐蔽、美观,有效恢复上颌骨的外形,义齿修复效果好,口腔、语言生理功能较满意。     

下唇癌病例的滑行块切除及修复

本文复习了各种下唇癌切除修复的方法,提出了下唇癌大块切除修复法。本法如图系一改良的下唇癌大块切除术,当下唇需切除40%时,此法足够切除肿瘤,手术后外形满意,不影响口角,及功能限制最小。在距病损8—10毫米处作纵行贯通式切口,内侧切口应终止于或恰在颏唇沟之上,比外侧纵行切口长2—3毫米更理想。下斜切口应与颏唇沟大致平行,在颏唇沟转向下处作三角形附加切口。病损大块切除后,外     

经耳后发际切口行下颌下腺切除术的临床总结

目的:探讨经耳后发际切口行下颌下腺切除术的可行性、术后并发症及美容效果.方法:此次临床总结纳入的患者共计63例,均来自福建医科大学附属三明市第一医院口腔颌面外科,于2015年1月—2020年10月期间以单侧下颌下腺良性病变为诊断收入院,均行患侧下颌下腺切除术.在这些患者中,38例采用传统的颌下手术切口入路(颌下切口组),25例采用耳后发际切口入路(耳后发际切口组).我们记录并比较2组的手术成功率、手术时间、神经损伤情况、术后面动、静脉出血及美容效果.结果:颌下切口组和耳后发际切口组所有患者的手术均顺利完成.在手术时间上,颌下切口组平均手术时间是(42.47±6.59)min,耳后发际切口组平均手术时间是(89.28±9.69)min,存在显著统计学差异(P<0.01).颌下切口组无神经损伤表现及术后面动、静脉出血,耳后发际切口组只有术后耳垂暂时性麻木3例,无面神经下颌缘支、舌神经及舌下神经损伤表现及术后面动、静脉出血.术后美容效果方面,颌下切口组的美容效果评分平均为4.42分,而耳后发际切口组的评分平均为8.04分,有显著统计学差异(P<0.01).结论:经耳后发际切口入路行下颌下腺切除术是一种安全可行的手术方法,而且相比传统的颌下切口入路,它的美容效果更好.     

Le Fort I ostectomy (using miniplates) for correction of the long face

The increased middle face height, with a short upper lip and visible upper alveolar process, is an indication for removing a slice of bone from the maxilla. Planning of the operation and operative procedures will be described. It is shown that osteosynthesis with miniplates without the need for intermaxillary fixation is possible, provided that the planning is painstaking and that a precise operative technique is used.     

Surgical correction of congenital lower lip sinuses in Van der Woude syndrome.

OBJECTIVE: To review the clinical outcome for patients with Van der Woude syndrome undergoing surgical excision of congenital lip sinuses. DESIGN: Retrospective chart review. SETTING: Multidisciplinary cleft-craniofacial team within a tertiary care hospital. PATIENTS, PARTICIPANTS: Seventeen patients with Van der Woude syndrome were identified from hospital records as having cleft lip and/or palate surgery performed at the University of Iowa, and six of these patients underwent simple surgical excision of lower lip sinuses. Main OUTCOME MEASURES: Incidence of postoperative complications and number of surgeries required per patient for correction of lower lip defect. RESULTS: All six patients undergoing surgical excision of lip sinuses had postoperative mucocele formation. These uniformly required one or two further surgeries for correction. There were no other complications associated with the procedures and no patient had a pre- or postoperative whistling deformity. Cosmetic outcome was thought to be satisfactory in all cases. CONCLUSIONS: Despite the overall improvement in cosmetic appearance following simple surgical excision of congenital lower lip sinuses, the high rate of mucocele formation and repeat surgery has led to cautious preoperative counseling regarding the risks and benefits of the procedure.     

Treatment of lower lip pits in Van der Woude syndrome: a systematic review

The presence of lower lip pits in individuals with Van der Woude syndrome (VWS) may cause discomfort due to saliva secretion. Furthermore, one of the main complaints in relation to lip pits is poor aesthetics, which often affects quality of life. The aim of this systematic review was to identify the best technique for the surgical removal of lower lip pits in terms of aesthetic and functional characteristics. A search of the PubMed, Embase, Web of Science, Science Direct, and Scopus databases was performed on December 27, 2016, which retrieved 88 records without duplicates. Among these papers, three ultimately met all eligibility criteria. The three studies included a total of 61 individuals, with follow-up ranging from 6 months to 10 years and sample collection from 10 to 24 years. The findings demonstrated that the outcome of surgical removal of lower lip pits was better with the use of vertical wedge excision, inverted-T lip reduction, Mutaf–Goldstein technique and modified simple excision than with simple excision. Simple excision may result in postoperative complications, such as mucocele and pit recurrence.     

A case of lower lip defect reconstructed with buccal mucosa and a tongue flap

The use of buccal mucosa and a tongue flap in reconstruction of full-thickness defects of the lower lip is described. The patient's face received a heavy blow in a traffic accident. Necrosis caused by hematogenous disturbance occurred in more than half of the entire lower lip vermilion. The patient underwent a two-stage operation for reconstruction of the lower lip. First, vestibuloplasty was performed using a buccal mucosal flap. Subsequently, the vermilion was surgically reconstructed using a flap from the tip of the tongue. This operative method is less risky because of its favorable prognosis. An effective way to recover motor function of the lower lip is to practice a rehabilitation program against scar contraction. An extension movement with the fingers that requires two or three repetitions every day was selected. Rehabilitation was started 7 days after the tongue flap was divided. The patient had a favorable recovery after the operation and is now able to wear a denture and to eat without slobbering.     

Differences in three-dimensional soft tissue changes after upper,lower, or both jaw orthognathic surgery in skeletal class III patients

The decision is not always straightforward as to which orthognathic procedure is best for a good aesthetic result; three-dimensional imaging has brought new insight into this topic. The aim of this prospective study was to verify objectively whether postoperative changes occur within those regions not directly affected by surgical movements of the underlying jaw bones. The study included 83 young adults with skeletal class III deformities. They were classified into three groups according to the type of surgery: bilateral sagittal split osteotomy set-back of the mandible (BSSO), Le Fort I advancement of the maxilla, or a combination of both. Pre- and postoperative optical scans were registered as regional best-fits on the areas of the foreheads and both orbits. The shell to shell differences were measured and the average distances between the observed regions were calculated. As expected, changes were greatest in the regions where the underlying bones had been moved, but regardless of the operation performed, changes were found over the whole face. Changes in the nose, cheek, and upper lip regions in the BSSO group and in the lower lip and chin region in the Le Fort I group confirmed the concept of the facial soft tissue mask acting as one unit.     

Surgical management of Squamous Cell Carcinoma of the lower lip: An experience of 109 cases

Objectives: We are presenting our experience collected from a series of 109 cases with SCC of the lower lip focusing on clinical features of patients and surgical approach. Study Design: We retrospectively analyzed medical records of patients diagnosed with Squamous Cell Carcinoma (SCC) of the lower lip at the Oral and Maxillofacial surgery at Xi’an Jiaotong University during a period between 1999 and 2008. Results: A total of 109 patients with lip cancer were included in the study. When no frozen-section test was performed, the neoplasia was removed with a margin of at least 6 mm. Different surgical techniques were used for lip reconstruction after tumor excision. Neck dissection was performed in all patients with clinically palpable lymph nodes. Median follow-up was 38 months. During follow-up, recurrence occurred in 5 patients, 3 patients developed neck metastases, distant metastases developed in 1 patient. Five patients died during observation period. Conclusions: The patient-related and defect-related issues must be taken into consideration during reconstruction for surgical defect. For N0 patients, we recommend wait-and-see policy. Early detection, careful follow-up and prompt neck is essential for the successful treatment. Key words:Lip cancer, surgical management, reconstruction.     

Dentocraniofacial morphology of 21 patients with unilateral cleft lip and palate: a cephalometric study.

OBJECTIVE: To assess the skeletal and dental craniofacial proportions of unilateral cleft lip and palate patients who were operated upon using the Malek technique, and compare them with a normal group to highlight the effect of surgical correction on craniofacial development during growth. DESIGN: Retrospective. METHODS: The cleft palate was closed using the Malek technique in a single operation at 3 months for 11 patients (complete closure of lip and palate) and in a two-stage operation for 10 patients (soft palate at 3 months, lip and hard palate at 6 months). Comparisons were made with a normal control group. Angular and linear measurements of anterior and posterior dimensions of the upper and lower compartments of the face were measured in the 7th and 12th years. RESULTS AND CONCLUSION: No significant differences were observed between the two groups of palate technique repair, although significant differences were observed between craniofacial dimensions of normal versus cleft lip and palate patients. At a skeletal level, the maxilla and mandible were retrusive relative to the cranial base in the cleft lip and palate group. In fact, there was a backward rotation of the palatal plane with repercussions on the maxillo-mandibular complex position. Furthermore, the maxilla was shorter than in normal patients, whereas the mandible was normally shaped. The upper incisors were retroclined and they locked the lower incisors in linguoversion. There was a posterior skeletal deficit of the respiratory compartment, compensated by more marked posterior maxillary alveolar growth. Facial growth in cleft lip and palate patients followed the same pattern, but was delayed compared with normal patients.     

Frozen section examination of the margins for resection of squamous cell carcinoma of the lower lip.

OBJECTIVES: Our goal was to evaluate the role of frozen section margin examination in the surgical management of squamous cell carcinoma of the lower lip. MATERIALS AND METHODS: We reviewed frozen section examination of the resection surfaces of 131 consecutive patients surgically treated for squamous cell carcinoma of the lower lip during the period January 1980 to January 1999. When invasive carcinoma or carcinoma in situ was present at the resection surface, the margin was defined as positive and re-resection was performed. RESULTS: A peroperative positive margin was seen in 18 of 131 (14%). In 8 patients (6%), a local recurrence developed. CONCLUSIONS: Frozen section examination for margin assessment in the surgical treatment of lip cancer is a reliable technique to control the radicality of the procedure; a secondary surgical procedure or postoperative radiotherapy can be reduced. However, a tumor-free resection surface does not guarantee that local recurrence will not occur.