颊肌肌粘膜瓣修复口腔癌术后缺损的临床研究

目的应用颊肌肌粘膜瓣修复口腔癌术后缺损10例.方法根据缺损大小和部位设计单侧或双侧,蒂在前或蒂在后的不规则梯形肌粘膜瓣。将其旋转修复不同部位缺损，6例修复舌、牙龈、口底、咽侧区，2例单侧修复翼下颌皱襞，2例双侧瓣修复口底正中缺损；结果本组病例肌粘膜瓣全部成活，l例近期有轻度开口受限，2周后恢复正常，口腔粘膜无明显修复痕迹及收缩现象。结论颊肌肌粘膜辨是口腔内软组织缺损理想的修复材料。     

颊肌骨粘膜瓣修复口腔癌术后缺损的临床研究

应用颊肌肌粘膜瓣修复口服癌术后缺损１０例。方法根据缺损大小和部位设计单侧或双侧,蒂在前或蒂在后的不规则梯形肌粘膜瓣。将其旋转修复不同部位缺损,６例修复舌、牙龈、口底、咽侧区,２侧单侧修复翼下颌皱襞,２例双侧瓣修复口底正中缺损。     

红唇切除后的修复

目前,多数学者对红唇切除后创面是采用简单的粘膜推进方法修复。此种方法常导致下唇内翻,外形不自然。作者设计一种口轮匝肌肌粘膜瓣结合VY改形的修复方法,并用其对12例下唇唇红缺损患者施行了修复手术,其中男性11例,女性1例,年龄最小44岁,仅4例在65岁以上。病变限于唇红内9例,涉及邻近皮肤1例;涉及唇粘膜2例。除3例曾进行过放疗外,吸烟及暴露于阳光下是普通致病因素。3例为红唇表浅浸蚀性鳞癌,施行了扩展性红唇切除。手术方法行红唇水平椭圆形切除,如累及邻近皮肤及粘膜需一并切除。处理浸蚀性鳞癌须将唇红及其     

颊全厚肌蒂推进瓣和扇形瓣修复下唇缺损的比较

近年来我科采用颊全厚肌蒂推进瓣修复下唇缺损 ,取得较为满意的效果 ,现报告如下1 .一般资料 :下唇缺损患者 30例 ,男 18例 ,女 12例 ,年龄 2 1～ 81岁 ,其中唇鳞癌 2 8例 ,血管瘤 1例 ,外伤 1例。2 .修复方法 :①颊全厚肌蒂推进瓣法 :此术式由谢桂成等[1] 改进提出 ,如图 1定点划线 ,沿Ａ、Ｃ线切开皮肤、肌肉 ,在其上缘连接一个三角形粘膜瓣 ,以备向外翻转与皮缘缝合形成红唇 ,并在粘膜下组织向龈颊沟剥离达下颌骨骨膜 ,顺骨膜向下颌缘分离。沿Ｂ、Ｄ、Ｃ线仅切开皮肤 ,在切口下缘真皮下血管网层下向下颌缘解剖分离。最后沿ＢＥ、ＣＦ将肌…     

面动脉逆行岛状颊肌粘膜瓣的临床应用

目的：探讨应用面动脉逆行岛状颊肌粘膜瓣修复口腔、鼻腔和眶区粘膜缺损的可行性。方法：对6例口、鼻腔和眶区粘膜缺损患者应用面动脉逆行岛状颊肌粘膜瓣修复。该瓣是以面动脉的远心端为血管蒂,通过前颊支和颊肌表面及其内部的血管网供血,在动脉周围包绕适量的软组织以利静脉回流,可通过皮下隧道转移到眶区或鼻腔,通过牙槽嵴裂隙转移到腭部。结果：6例患者术后肌粘膜瓣完全成活,效果满意,无血肿、感染、腮腺导管损伤、面神经损伤和开口功能障碍等。结论：面动脉逆行岛状颊肌粘膜瓣血运好,转移灵活,可以解决常规方法难以修复的口腔前部、鼻腔、眶区粘膜缺损。     

颊肌肌粘膜瓣的应用解剖学研究

颊肌肌粘膜瓣的应用解剖学研究王卫之，李跃，孙涌泉自１９７１年Ｃｏｈｅｎ应用颊肌肌粘膜瓣修复口底部缺损以来，颊肌肌粘膜瓣已用于上下颌骨缺损、腭裂等多种疾病缺损的修复。本文对颊肌形态、颊动脉供应作了较为详细观察，现将１８具（３６侧）尸解结果报告如下。１．...     

口周肌黏膜瓣在红唇缺损修复中的应用

目的:探讨口周肌黏膜瓣在红唇缺损修复中的临床效果。方法:根据红唇缺损部位及面积,在上、下唇及颊部设计肌黏膜瓣,长宽比例最大2.5:1,肌黏膜瓣取肌肉浅层,通过局部旋转、推进的方法修复红唇缺损,肌黏膜瓣转移后遗留的创面直接拉拢缝合。结果:25例患者实施口周黏膜瓣修复红唇缺损手术,肌黏膜瓣完全成活,成活率100%,修复后唇外形良好,无明显瘢痕,整形美容效果好。结论:该方法手术设计简单且易操作,以黏膜下肌肉蒂为主要血供,无需解剖血管蒂,是红唇缺损修复较为理想的方法。     

颈阔肌肌皮瓣立即整复口腔颌面部缺损(临床应用及评价)

本文回顾了我科1985年至1992年间27例颈阔肌肌皮瓣用于颊癌、舌癌、口底癌、唇癌、颧颊腮腺区蔓状血管瘤、颞颌关节强直和放射性下唇缺损等患者手术后的缺损整复。在肌皮瓣的设计上,作者采用双蒂横向桥形瓣修复全下唇缺损,在应用上将颈阔肌肌皮瓣用于大面积颧颊腮腺区蔓状血管瘤术后缺损的整复.     

双侧红唇瓣修复下唇缺损

下唇缺损修复方法较多,但在某种程度上要牺牲正常组织,或留有明显瘢痕。作者参考Goldstein单侧红唇瓣修复半侧红唇缺损的方法,并加以改进,使用双侧红唇瓣修复下唇缺损5例。缺损重建方法取决于两种情况。一是单纯红唇缺损,直接选用双恻红唇瓣修复(图1);二是红唇伴有白唇缺损,使用双侧红唇瓣同时应用带有皮下蒂的V-     

面动脉肌粘膜瓣(FAMM):一种新型的口内组织瓣

鼻唇瓣和颊粘膜瓣已在面中份重建中得到广泛应用,作者将两者结合,设计出以面动脉为蒂的新型轴型肌粘膜瓣,称之为面动脉肌粘膜瓣(FAMM),上蒂型或下蒂型均可。临床应用18例,仅1例失败。2例部分坏死。此瓣包括粘膜、粘膜下组织、少部分颊肌、口轮匝肌深层、面动脉和静脉丛,可用于修复口腔及鼻腔粘膜缺损。应用解剖面动脉为颈外动脉的分支,在嚼肌前缘绕过下颌骨下缘到达面部,其行程曲折,向上、前至口角外侧,位于笑肌、颧大肌和口轮匝肌浅层深面,颊     

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.     

Versatility of the buccinator myomucosal flap in atypical palate reconstructions

Initially described for the treatment of cleft palate, the anatomical bases of the buccinator myomucosal flap were described by Bozola et al. (1989). A meticulous search found several reports of its use for the correction of post-palatoplasty oronasal fistulas, with only a few reports of its use for other palate-related pathologies.A retrospective analysis was undertaken of patients treated by the Plastic Surgery Units at the Rio de Janeiro Federal University Hospital (HU-UFRJ) and the São Paulo University Hospital (HC-USP), suffering from palatal lesions not associated with a cleft palate and treated through the use of buccinator myomucosal flaps.The average age was 47 years, with 70% of the patients being male. Assorted aetiologies were noted for palatal defects. When there was significant damage to the soft palate, a superior base pharyngeal flap was used. Of this total, in 71% of the cases only the buccinator myomucosal flap was used. In all cases, the flaps were unilateral, adequately covering the defects in question. The buccinator myomucosal flap is a good option for reconstructing medium to large palate defects, as it is a flap with good vascularization and dimension, in addition to an ample arc of rotation, with primary closure of the donor site, without adding significant morbidity.     

Three-dimensional primary reconstruction of anterior mouth floor and ventral tongue using the 'trilobed' buccinator myomucosal island flap

Three-dimensional reconstruction of the anterior mouth floor and ventral tongue after ablative surgery can be achieved using several techniques. The ideal reconstruction should be accomplished with the same or similar type of tissue, and cheek axial myomucosal flaps based on the branches of facial or internal maxillary arteries seem ideal for this purpose. From March 2005 to May 2007, 23 patients underwent cheek axial myomucosal flap reconstruction after oral cancer surgical ablation. Thanks to their thinness and pliability, these flaps were frequently shaped to obtain an accurate reconstruction. According to Whetzel's hypothesis, an intraoral flap designed to include the axial vessel of one area can safely carry the mucosa of a neighbouring vascular area. The authors describe a large buccinator myomucosal island flap based on the branches of the facial artery and formed in a trilobed shape in order to capture the adjacent buccal mucosal angiosome from the internal maxillary artery. The flap provided the correct anatomical oral reconstruction for the anterior mouth floor and ventral tongue. The function of the tongue, oral intake and mastication were not impaired. The trilobed buccinator myomucosal island flap is a suitable option for the three-dimensional reconstruction of the anterior mouth floor and ventral tongue.     

轴型唇红组织瓣并颏下唇粘膜蒂肌皮瓣修复下唇缺损

对于唇缺损的整复应尽可能地应用局部或邻近区域组织瓣来恢复它的正常解剖形态和生理功能已成为公认的基本原则。本文描述了一种整复下唇缺损的新的手术方法。该方法充分利用缺损后的唇红和白唇组织，恢复口轮匝肌和唇红的完整性，使唇缺损的修复效果达到了外形与功能的完美统一。本文就该手术方法的解剖学基础，手术操作要点以及手术的适应证等问题做了较为详尽的讨论。     

Aesthetic upper lip reconstruction with vermilion submucosal-pedicle cross-lip flap

The localized cutaneous amyloidosis occurring on the upper lip of a 48-year-old man was surgically treated and aesthetically reconstructed with vermilion submucosal pedicle partial-thickness cross-lip flap. The reconstruction of the upper lip following the tumor resection or trauma with Abbe flap or its modified methods may not be always satisfactory because it leaves parallel scars extending to the free vermilion margin and trapdoor deformity. We considered that the replacement of free margin of the upper vermilion with that of the lower vermilion might be responsible for it. When significant vermilion is lost, some surgeons may discard its free margin additionally or convert this defect to a through-and-through defect for easier repair. We believe that surgeon should preserve a continuity of the free margin of upper-lip if possible. Our modified Abbe flap can be applied for a various defects of the upper lip so far as the free margin of the vermilion can be preserved.     

肌功能性重建在面横裂整复中的应用

目的：总结9例先天性面横裂的手术治疗体会，探讨肌功能性重建术在面横裂整复中的作用。方法：采用上唇黏膜瓣联合皮肤“Z”字成形术整复先天性面横裂9例，术中解剖复位口轮匝肌和颊肌进行肌功能性重建。结果：所有病例创口均I期愈合，无口角裂开或瘘管形成。无论静态或动态时，双侧口角形态自然对称，面颊部无明显凹陷性畸形。结论：上唇黏膜瓣联合皮肤“Z”字瓣法整复先天性面横裂，设计简单，操作方便，术中经肌功能性重建后可形成圆滑自然的口角及丰满的面颊部形态，且不影响张口，值得推广。     

Standard morphology of the oral commissure and changes resulting from reconstruction for defects involving the commissure

The aim of this study was to characterize the standard morphology of the oral commissure and to describe the changes after reconstruction in patients with through-and-through cheek defects involving the oral commissure. Indices for the morphological analyses of the commissure were derived from examinations of 50 normal Japanese volunteers. Ten patients with full-thickness cheek defects involving the commissure were then evaluated. All of these patients underwent free flap reconstruction with vermilion advancement flaps from the remaining vermilion. The morphology of the commissure with the mouth closed was classified based on the point of entrance of the vermilion into the oral cavity. In normal volunteers, the commissure pattern consisting of the entrance of the upper vermilion into the oral cavity before the lower vermilion and just prior to forming the oral commissure was considered to be the standard. However, in the reconstructed cases, there was an increase in the pattern in which the lower vermilion enters the oral cavity before the upper vermilion for the remaining commissure postoperatively, especially when the lower lip defects were greater than those of the upper lip. It is important to refer not only to the standard morphology of the commissure, but also to the changes according to the extent of resection and the method of reconstruction.     

Algorithm for the treatment of oral and peri-oral defects through local flaps

Purpose

Local flaps are currently considered the main reconstructive option for medium-size oral and peri-oral defects; however, their indications are sometimes challenging to select. The aim of this study was to critically analyse their selection and to propose a therapeutic algorithm.

Rational and simplified nomenclature for buccinator myomucosal flaps

Background

Reconstruction of moderate-sized mucosal defects of the oral cavity or oropharynx represents a surgical challenge. Buccinator myomucosal flaps seem to provide “ideal reconstruction” of oral/oropharyngeal defects because they carry a thin, mobile, well-vascularized, and sensitive tissue, like that excised or lost. Nevertheless, these flaps are not immediately popular because of confusion surrounding the complex terminology used to name them.

Methods

After a retrospective study on our experience and a literature review, the authors propose a new rational and simplified nomenclature for the classification of buccinator myomucosal flaps, which clarifies the source vessel, the composition of the flap, and the type of transfer.

Results

According to this nomenclature, six types of buccinator myomucosal flaps are described.

Conclusions

This proposed nomenclature may bring a consensus on the classification of buccinator myomucosal flaps and can help their spread.

     

单侧唇裂修复术中唇红三角瓣术前术后定量分析

目的:单侧唇裂红唇修复中唇红三角瓣的设计进行术前数据的定量分析,及通过术后数据的定量分析对术后效果进行评价。方法:青岛大学附属医院26例单侧唇裂患儿,手术前后进行健患侧各项数据的测量,术前数据包括健患侧唇长、干唇长、唇红三角瓣边长及底长;利用医学统计学方法得出术前数据的相关性并进行唇红三角瓣的设计,为单侧唇裂唇红修复时三角瓣的设计提供理论参考。术后测量数据包括健患侧唇长、干唇高度及唇高,运用医学统计学分析健患侧有无差异,从主观及客观两方面分析术后唇红部形态、对称性及患儿上唇唇红部形态等,综合评价手术中设计唇红三角瓣的效果。结果:唇裂裂隙程度与唇红三角瓣底长有明显的相关性,术前健侧与裂隙缘唇峰干唇的高度差和红唇三角瓣底长呈正相关(P＜0.05);26例唇红修复主观评价项平均得分均大于4分,客观评价术后健患侧干唇高度、唇高、唇长均无差异,整复效果令人满意。结论:依照本文设计唇红三角瓣的方法修复单侧唇裂可使上唇唇红获得良好形态效果。