Repair of large orbito-maxillofacial defects following resection of tumors with temporalis myofascial flap and facial-cervico-pectoral flap

PURPOSE: To evaluate the results of facial-cervico-pectoral rotation flap (FRF) and temporalis myofascial flap (TMF) in the repair of large soft tissue defect in oral and maxillofacial regions. METHODS: Six patients with malignant orbital tumors and/or maxillofacial tumors invading the orbital regions were treated with extensive resection. The major midfacial soft tissue defects were repaired by temporalis myofascial flap and facial-cervico-pectoral rotation flap. RESULTS: All flaps were successfully transferred; the result of facial aesthetics was satisfactory in all patients. Follow-up periods varied from 9 to 20 months (mean follow up period: 13.2 months) and all of the patients were alive during the follow-up period with one recurrence. CONCLUSIONS: The TMF and the FRF are easy to harvest, have low donor site morbidity, and are compatible with the principles of oncologic resection. It is the method of choice for repairing major orbito-maxillofacial skin defects following resection of the tumors.     

前臂皮瓣修复舌癌术后舌缺损患者的生存质量评价

目的 分析评价前臂皮瓣修复舌鳞状细胞癌术后舌缺损患者的术后生存质量.方法 应用美国华盛顿大学生存质量问卷(University of Washington head and neck quality-of-life questionnaire,UW-QOL)对112例舌鳞状细胞癌术后前臂皮瓣修复舌缺损患者行生存质量评价,并对不同程度、不同部位舌缺损患者的术后生存质量进行对比分析.结果 112例患者的总体生存质量得分为959.6分,达到总分的80%(960/1200);舌缺损≤1/2全舌(＞1/3全舌)患者的总体生存质量得分(979.8分)明显高于舌缺损＞1/2全舌患者(901.7分),其中语言功能的恢复存在明显差异,两组患者的平均得分分别为71.1和58.6分(P＜0.05);缺损未涉及舌根和涉及舌根的患者术后生存质量得分分别为981.6和950.0分,差异无统计学意义(P＞0.05).结论 前臂皮瓣是舌缺损重建的良好选择,修复舌根部缺损也能获得良好治疗效果;前臂皮瓣更适合用于≤1/2全舌(＞1/3全舌)的舌缺损重建.

Abstract：

Objective To evaluate the quality-of-life outcomes in patients with tongue cancer following reconstruction with free forearm flap. Methods Quality-of-life (QOL) outcomes of 112 patients of tongue reconstruction with free forearm flap were assessed using University of Washington head and neck QOL questionnaire (UW-QOL). The QOL outcomes of the patients with different defect range and site were also compared. Results The overall mean QOL scores of the 112 patients was 959. 6, which reached about 80% (960/1200)of the overall score. The QOL scores of the patients with defects not more than 1/2 tongue ( more than 1/3 tongue) were significantly higher than those with defects more than 1/2 tongue ( P ＜0.05 ).There was no significant difference between the QOL scores of the patients with and without tongue base defect (P ＞ 0.05 ). Conclusions Free forearm flap is a good choice for tongue reconstruction and more suitable for the reconstruction of the defects not more than 1/2 tongue ( more than 1/3 tongue).     

改良式压膜保持器与Hawley保持器在下颌后缩患者保持疗效的比较研究

Objective To compare the clinical effects of modified Vacuum-formed retainer with that of Hawley retainer in patients with Class Ⅱ mandibular retrusion. Methods Thirty Class Ⅱ cases were selected. The patients were divided into two groups (one with modified Vacuum-formed retainer, the other with Hawley's retainer). Lateral cephalometric films taken before and after treatment were analyzed. The effects were compared between two groups. Results After 12 months of retention, the overjet and overbite of the 15 cases increased in the control group. Normal overjet and overbite of the 15 cases in the experimental group were established. The molar relationship was Class Ⅰ. Conclusions Compared with Hawley's retainer, modified Vacuum-formed retainer could effectively balance the jaw relationship.     

改良式压膜保持器与Hawley保持器在下颌后缩患者保持疗效的比较研究

Objective To compare the clinical effects of modified Vacuum-formed retainer with that of Hawley retainer in patients with Class Ⅱ mandibular retrusion. Methods Thirty Class Ⅱ cases were selected. The patients were divided into two groups (one with modified Vacuum-formed retainer, the other with Hawley's retainer). Lateral cephalometric films taken before and after treatment were analyzed. The effects were compared between two groups. Results After 12 months of retention, the overjet and overbite of the 15 cases increased in the control group. Normal overjet and overbite of the 15 cases in the experimental group were established. The molar relationship was Class Ⅰ. Conclusions Compared with Hawley's retainer, modified Vacuum-formed retainer could effectively balance the jaw relationship.     

OSAHS患者戴用口腔矫治器后颅面、上气道改变的追踪研究

Objective To investigate dental and skeletal changes of oral appliance treating of obstructive sleep apnea and hypopnea syndrome in long-term treatment. Methods A total of 25 patients were included in the study.The cephalometric study was used to investigate the dental,skeletal and airway changes.Results 25 patients were treated with an oral appliance for a mean duration of 5 years.Significant retroclination of the maxillary incisors(3.34±3.36°,P＜0.001)and proclination of the mandibular incisors(1.78±3.06°,P=0.008)were accompanied by reductions in overbite(1.46±1.12 mm,P＜0.001)and oveoet(1.12±0.99 mm,P＜0.001).The MP-FH,MPSN angles increased 1.3°,the face height and the distance between the hyoid and FH plane increased.Conclusions The orthodontic side-effects on the dental,skeletal and airway are sinail during the treatment of patients with OSAHS.     

固定矫治对错(牙合)患者口腔健康相关生活质量的影响

Objective To assess oral health-related quality of life in patients with fixed appliances.Methods Orthodontic patients were asked to complete the scale of general conditions(Chinese version,questionnaire 1)and oral health impact profile(OHIP)-14(Chinese version,questionnaire 2).Baseline data were collected at first visit and thereafter.The subjects finished questionnaire 2 at the 1st week,4th week,12th week and 24th week,respectively,after the fixed appliance was bonded.Data were analyzed to evaluate the various sample groups with different personal information and clinical parameters.Results were collated and analyzed using software package SPSS version 15.0.Results The most common negative effect was physical pain[55/222(27.8%)]and psychological discomfort[40/222(18.0%)],mainly in the first month.The total scores at five time points were 3,10,7,5 and 4,respectively.No difference was found in quality of life in patients between sixth month with fixed appliance and without appliance(P＞0.05).Age and education status affected the quality of life(P＜0.001).Conclusions Fixed orthodontic appliance therapy affected patients' oral health-related quality of life during treatment.The quality of life in the first month of treatment was mostly compromised and was improved later.     

固定矫治对错(牙合)患者口腔健康相关生活质量的影响

Objective To assess oral health-related quality of life in patients with fixed appliances.Methods Orthodontic patients were asked to complete the scale of general conditions(Chinese version,questionnaire 1)and oral health impact profile(OHIP)-14(Chinese version,questionnaire 2).Baseline data were collected at first visit and thereafter.The subjects finished questionnaire 2 at the 1st week,4th week,12th week and 24th week,respectively,after the fixed appliance was bonded.Data were analyzed to evaluate the various sample groups with different personal information and clinical parameters.Results were collated and analyzed using software package SPSS version 15.0.Results The most common negative effect was physical pain[55/222(27.8%)]and psychological discomfort[40/222(18.0%)],mainly in the first month.The total scores at five time points were 3,10,7,5 and 4,respectively.No difference was found in quality of life in patients between sixth month with fixed appliance and without appliance(P＞0.05).Age and education status affected the quality of life(P＜0.001).Conclusions Fixed orthodontic appliance therapy affected patients' oral health-related quality of life during treatment.The quality of life in the first month of treatment was mostly compromised and was improved later.     

固定矫治对错(牙合)患者口腔健康相关生活质量的影响

Objective To assess oral health-related quality of life in patients with fixed appliances.Methods Orthodontic patients were asked to complete the scale of general conditions(Chinese version,questionnaire 1)and oral health impact profile(OHIP)-14(Chinese version,questionnaire 2).Baseline data were collected at first visit and thereafter.The subjects finished questionnaire 2 at the 1st week,4th week,12th week and 24th week,respectively,after the fixed appliance was bonded.Data were analyzed to evaluate the various sample groups with different personal information and clinical parameters.Results were collated and analyzed using software package SPSS version 15.0.Results The most common negative effect was physical pain[55/222(27.8%)]and psychological discomfort[40/222(18.0%)],mainly in the first month.The total scores at five time points were 3,10,7,5 and 4,respectively.No difference was found in quality of life in patients between sixth month with fixed appliance and without appliance(P＞0.05).Age and education status affected the quality of life(P＜0.001).Conclusions Fixed orthodontic appliance therapy affected patients' oral health-related quality of life during treatment.The quality of life in the first month of treatment was mostly compromised and was improved later.     

固定矫治对错(牙合)患者口腔健康相关生活质量的影响

Objective To assess oral health-related quality of life in patients with fixed appliances.Methods Orthodontic patients were asked to complete the scale of general conditions(Chinese version,questionnaire 1)and oral health impact profile(OHIP)-14(Chinese version,questionnaire 2).Baseline data were collected at first visit and thereafter.The subjects finished questionnaire 2 at the 1st week,4th week,12th week and 24th week,respectively,after the fixed appliance was bonded.Data were analyzed to evaluate the various sample groups with different personal information and clinical parameters.Results were collated and analyzed using software package SPSS version 15.0.Results The most common negative effect was physical pain[55/222(27.8%)]and psychological discomfort[40/222(18.0%)],mainly in the first month.The total scores at five time points were 3,10,7,5 and 4,respectively.No difference was found in quality of life in patients between sixth month with fixed appliance and without appliance(P＞0.05).Age and education status affected the quality of life(P＜0.001).Conclusions Fixed orthodontic appliance therapy affected patients' oral health-related quality of life during treatment.The quality of life in the first month of treatment was mostly compromised and was improved later.     

固定矫治对错(牙合)患者口腔健康相关生活质量的影响

Objective To assess oral health-related quality of life in patients with fixed appliances.Methods Orthodontic patients were asked to complete the scale of general conditions(Chinese version,questionnaire 1)and oral health impact profile(OHIP)-14(Chinese version,questionnaire 2).Baseline data were collected at first visit and thereafter.The subjects finished questionnaire 2 at the 1st week,4th week,12th week and 24th week,respectively,after the fixed appliance was bonded.Data were analyzed to evaluate the various sample groups with different personal information and clinical parameters.Results were collated and analyzed using software package SPSS version 15.0.Results The most common negative effect was physical pain[55/222(27.8%)]and psychological discomfort[40/222(18.0%)],mainly in the first month.The total scores at five time points were 3,10,7,5 and 4,respectively.No difference was found in quality of life in patients between sixth month with fixed appliance and without appliance(P＞0.05).Age and education status affected the quality of life(P＜0.001).Conclusions Fixed orthodontic appliance therapy affected patients' oral health-related quality of life during treatment.The quality of life in the first month of treatment was mostly compromised and was improved later.     

斜方肌骨肌皮瓣在修复半侧下颌骨切除及口腔软组织缺损中的应用

目的：评价斜方肌骨肌皮瓣修复口腔软组织和半侧下颌骨切除术后缺损的可靠性。方法：10例口腔、颌骨恶性肿瘤患者行半侧下颌骨和累及的软组织手术切除，术后缺损采用斜方肌骨肌皮瓣修复。男6例，女4例，年龄45～79岁，平均年龄61．2岁。T4N0M0期3例，T4N1M0期7例。皮瓣大小为（7cm×6cm）～（16cm×8cm）。结果：8例患者皮瓣全部成活。2例患者皮瓣边缘略有坏死。随访观察7～24个月，7例患者生存良好，无复发；1例患者死于肝、肺转移；2例患者术后复发，行二次手术，目前尚存活。结论：斜方肌骨肌皮瓣是一种修复口腔软组织和下颌骨半侧切除遗留的巨大缺损可靠的方法。     

面动脉-颏下动脉岛状皮瓣修复半舌缺损

目的:探讨面动脉-颏下动脉岛状肌皮瓣修复舌癌术后缺损的效果。方法:2007-01—2008-01收治舌鳞癌患者35例,其中男20例,女15例。全部采用面动脉-颏下动脉岛状肌皮瓣对舌癌根治性切除后半舌缺损进行同期整复,皮瓣最小6.0 cm×4.0 cm,最大12.0 cm×5.0 cm。结果:面动脉-颏下动脉岛状肌皮瓣存活率为94.29%(33/35),患者语言、吞咽功能良好,面部外形满意。2例术后淋巴结转移复发,其中1例治疗后存活,1例死亡。结论:面动脉-颏下动脉岛状肌皮瓣安全、操作简单快速、成活率高,适合同期修复舌癌术后半舌缺损。     

面-颏下动脉岛状皮瓣修复年轻与老年舌癌患者的效果比较

目的:评估面-颏下动脉岛状肌皮瓣（facial-submental artery island flap,FSAIF）修复年轻与老年舌癌患者的效果。方法:选取2008年1月—2017年6月中山大学孙逸仙纪念医院口腔颌面外科收治的舌鳞状细胞癌（tongue squamous cell carcinoma,TSCC）患者96例,所有患者均采用FSAIF进行肿瘤切除后半舌缺损的同期整复;按年龄分为< 60岁（62例）及≥ 60岁（34例）2组;皮瓣大小分别为3 cm×6 cm~5 cm×12 cm（<60岁）和3 cm×9 cm~5 cm×15 cm （≥60岁）。所有患者均未行术后放疗,术后对每例患者随访并观察吞咽、言语功能及美观效果。采用SPSS 20.0软件包对数据进行统计学分析。结果:3例患者皮瓣失败,皮瓣存活率为96.9% （93/96）,2组皮瓣存活率无显著差异;2组患者吞咽、言语、美学及后期生存状态无显著差异。结论:FSAIF适用于修复肿瘤切除后的半舌缺损,无论年轻还是年老患者。     

面动脉-颏下动脉肌皮瓣在口腔颌面部软组织缺损修复中的应用

目的探讨面动脉-颏下动脉肌皮瓣在口腔颌面部缺损修复中的应用。方法应用面动脉一颏下动脉肌皮瓣修复口腔颌面部软组织缺损病例12例,皮瓣面积最小为5cm×4cm,最大为12cm×6cm。术后随访．观察皮瓣的成活情况、外形和功能、癌肿复发以及患者的生存状况。结果12例皮瓣均成活,术后6个月,所有患者受区形态及功能恢复良好,无明显的颈部活动受限。随访1—5年,均未出现颏下及颌下区淋巴转移及皮瓣内癌肿的复发。结论面动脉一颏下动脉肌皮瓣制备较简易,成活率高,在口腔癌术后缺损中具有较好的修复效果。     

应用对侧逆行内眦动脉瓣修复面中部皮肤癌术后缺损

目的:评价对侧逆行内眦动脉瓣用于修复面中部皮肤癌术后中到大型缺损的可行性。方法:12例面中部皮肤癌患者,男9例,女3例,年龄55～76岁。其中,基底细胞癌7例,鳞状细胞癌4例,恶性黑色素瘤1例。手术切除肿瘤后,采用对侧逆行内眦动脉岛状皮瓣修复缺损。缺损大小为3.0cm×3.0cm～5.0cm×7.0cm,皮瓣大小为2.0cm×4.0cm～4.0cm×6.0cm。结果:12例移植皮瓣均成活,随访6～12个月,平均8.5个月。多数皮瓣血供良好,功能正常,色泽、质地良好,术后供区瘢痕隐蔽。结论:对侧逆行内眦动脉瓣修复面中部皮肤癌术后中到大型缺损简单、安全,疗效稳定。     

应用游离股前外侧皮瓣重建舌癌术后组织缺损

目的:探讨应用游离股前外侧肌皮瓣修复舌癌术后组织缺损的临床效果。方法 :2008-01—2011-01应用股前外侧肌皮瓣修复舌癌术后组织缺损19例,其中男性11例,女性8例,年龄29岁至65岁,平均年龄50岁。病理类型:高分化鳞癌15例,中分化鳞癌4例。按UICC标准TNM分期:T2N0M0 5例,T3N0M0 8例,T3N1M0 4例,T4N1M0 2例;皮瓣大小为(8 cm×5 cm)^{(15 cm×7 cm)}。结果:19例股前外侧肌皮瓣全部成活,全部病例面颈部创面及大腿皮瓣供区均一期愈合。所有患者舌部缺损修复形态良好,患者语音、咀嚼、吞咽功能恢复良好,手术前后对比,未见明显颌面部畸形。术后随访1(15 cm×7 cm)。结果:19例股前外侧肌皮瓣全部成活,全部病例面颈部创面及大腿皮瓣供区均一期愈合。所有患者舌部缺损修复形态良好,患者语音、咀嚼、吞咽功能恢复良好,手术前后对比,未见明显颌面部畸形。术后随访1³年,1例患者术后1年出现对侧颈部淋巴结及全身骨转移并死亡,余患者未见转移和复发。结论:股前外侧皮瓣组织量丰富,适用于口腔颌面部癌肿术后组织缺损修复及器官功能恢复;因其供区隐蔽,对供区影响小,尤其适合年轻女性患者。     

面动脉瓣修复口咽癌术后缺损

目的探讨面动脉瓣修复口咽癌术后缺损的效果及临床应用。 方法选择2008年5月至2014年1月中山大学孙逸仙纪念医院口腔颌面外科收治的口咽癌患者33例,行肿瘤扩大切除术同期采用顺行或逆行面动脉瓣修复组织缺损。 结果33例面动脉瓣中,逆行性皮瓣11例全部成活,而顺行性皮瓣成活18例、部分坏死2例、完全坏死2例。皮瓣成活病例伤口愈合良好,患者术后语音和吞咽功能得到恢复。 结论应用面动脉岛状肌皮瓣修复口咽癌切除术后缺损,制取技术简单,皮瓣血供明确,皮瓣成活率高,瘢痕较为隐蔽,是修复口咽癌切除术后缺损的理想皮瓣。     

逆行面动脉-颏下动脉岛状肌皮瓣修复口腔颌面部缺损的探讨

目的评价逆行面动脉-颏下动脉岛状肌皮瓣修复口腔颌面部缺损的可行性。方法用逆行面动脉-颏下动脉岛状肌皮瓣修复18例恶性肿瘤切除术后口腔颌面部缺损。男性11例，女性7例，年龄28～90岁。舌鳞癌7例、颊黏膜鳞癌4例、腭鳞癌3例、口咽癌和面部皮肤基底细胞癌各2例。肌皮瓣面积最小为4．0cm×12．0cm，最大为5．0cm×15．0cm。结果17例肌皮瓣存活，1例缺血坏死。肌皮瓣受区外观满意、功能恢复良好，供区瘢痕隐蔽。经术后6～18个月，平均11．8个月随访，1例术后10个月对侧颈部淋巴结转移。结论逆行面动脉-颏下动脉岛状肌皮瓣是口腔颌面部中型缺损的理想修复材料。     

改良胸大肌肌皮瓣与传统胸大肌肌皮瓣修复头颈大型缺损的疗效比较

目的:本研究目的为比较改良胸大肌肌皮瓣(modified pectoralis major myocutaneous flap,mPMMF)与传统胸大肌肌皮瓣pectoralis major myocutaneous flap,PMMF)在修复颌面部及口咽部恶性肿瘤术后大型缺损的效果.方法:本研究纳入28例原发口腔颌面...     

折叠延长下斜方肌岛状皮瓣修复面颊部巨大洞穿性缺损

目的:探讨应用折叠延长下斜方肌岛状皮瓣修复面颊部巨大洞穿性缺损的可行性。方法:16例(男10例,女6例,年龄17～75岁,平均年龄55.4岁)面颊部恶性肿瘤扩大切除后面颊部巨大洞穿性缺损患者,采用折叠延长下斜方肌岛状皮瓣修复。皮岛宽7～8 cm,长8～31 cm,折叠修复面颊部洞穿性缺损,恢复口腔内衬里及外侧颊部皮肤。结果:16例皮瓣全部成活。患者面颈部外观良好,口腔功能满意。结论:折叠延长下斜方肌岛状肌皮瓣可作为修复口腔恶性肿瘤根治术后所致面颊部巨大洞穿性缺损的首选皮瓣,其操作简便,安全可靠。