应用肾形棉垫加压包扎预防腮腺术后涎瘘

目的:研究肾形棉垫加压包扎在腮腺手术中的应用价值,探讨腮腺术后涎瘘发生的有关因素。方法:196例腮腺良性肿瘤和瘤样病变,随机分为肾形棉垫组(100例)和传统包扎组(96例)。分析2组术后涎瘘发生率,同时分析不同术式、腮腺主导管是否结扎等因素和涎瘘发生的关系。采用SPSS13.0软件包对数据进行χ2检验。结果:棉垫组涎瘘发生率为1%,传统组发生率为13.54%,2组差异显著(P<0.01)。不同术式、腮腺主导管是否结扎和涎瘘发生无明显关系(P>0.05)。结论:肾形棉垫加压包扎能有效预防腮腺术后涎瘘发生,具有临床应用价值。     

Use of the serratus anterior free flap to treat a recurrent oroantral fistula

We describe the successful use of the serratus anterior free muscle flap to obliterate a recurrent oroantral fistula in a 39-year old male who 19 years before this surgery had sustained a high velocity impact to his right face with multiple subsequent corrective surgeries. There was no complication from the serratus anterior free flap surgery and no postoperative scapular winging. The serratus anterior muscle is a versatile flap and ideal for various defects. It should be considered for obliteration of oroantral fistulas when no local or regional tissue is available because of previous surgery or trauma.     

SMAS folded flap and allograft dermal matrix repairing parotid bed following parotidectomy to prevent facial deformity and Frey''''s syndrome

PURPOSE:This study evaluates the outcome of superficial musculoaponeurotic system(SMAS) and allograft dermal matrix(ADM) in preventing facial deformity and Frey's syndrome following parotidectomy.METHODS:Forty-six patients with benign parotid tumors were randomly assigned to 4 groups.The control group consisted of 12 patients who underwent a total parotidectomy;The AMD group consisted of 10 patients who underwent a total parotidectomy and underwent intraoperative placement of ADM within the parotid bed;SMAS group consisted of 11patients who underwent a total parotidectomy and SMAS folded flaps to repair parotid bed;and SMAS plus AMD group consisted of 13 patients who underwent a total parotidectomy and intraoperative placement of ADM to repair parotid bed with SMAS folded flaps.All 46 patients were evaluated via a short questionnaire regarding perception of a facial contour deformity,Frey's syndrome,modified Minor's starch-Iodine test(MSIT) ,and clinical examination.RESULTS:Twelve months of follow-up was conducted after the treatment,the rates of satisfaction with the post-operative facial contour were 33.3%(4/12) ,40.0%(4/10) ,91.9%(10/11) and 100%(13/13) respectively in the control group,AMD group,SMAS group and SMAS plus AMD group,and the difference between the SMAS plus AMD group and the former two groups was statistically significant(P< 0.05) .The incidences of objective Frey's syndrome by MSIT were 50.0 %(6/12) ,20.0%(2/10) ,27.3%(3/11) and 7.7%(1/13) respectively,and the difference between the SMAS plus AMD group and the control groups was statistically significant(P<0.05) .CONCLUSION:The SMAS folded flap is clinically simple to perform,which can prevent depressed facial deformity.Combination of SMAS folded flap and ADM can reduce the incidence of Frey's syndrome in patients undergoing parotidectomy.     

Vein graft repair of a chronic parotid duct fistula

A long-standing fistula of Stensen's duct with severe atrophy of the distal duct was repaired successfully by replacement with a 5 cm autologous saphenous vein graft.     

Waltzing a facial artery musculomucosal flap to salvage a recurrent palatal fistula

Closure of a palatal fistula, especially after multiple recurrences, remains a complex reconstructive problem. Herein, salvage of a recurrent palatal fistula after a facial artery musculomucosal flap (FAMM) flap by use of the traditional waltzing (jumping, migration) principle of tubed pedicle flaps is presented and the principles are discussed.     

Use of a latissimus dorsi myocutaneous flap for closure of an orocutaneous fistula of the cheek

The latissimus dorsi myocutaneous flap can be used successfully for external cover in the cheek region when the nature of the defect precludes the use of other local or regional flaps. It is exceedingly useful when a large amount of well-vascularized tissue is needed. The flap is extremely reliable and versatile as a one-stage reconstruction. Its major drawbacks are its bulkiness and the necessity to reposition the patient intraoperatively.     

腮腺筋膜和耳大神经保留的改良方法

目的：介绍～种腮腺切除术中保留耳大神经和腮腺筋膜的改良方法。方法：取常规s形切口,在腮腺筋膜浅面先向前游离皮瓣至腮腺近前缘,再于耳垂前1cm处纵形切开腮腺筋膜,在腮腺筋膜深面、腮腺组织表面向后游离至胸锁乳突肌,形成皮肤筋膜瓣。在游离过程中,将耳大神经主干及耳垂支、耳后支保留在皮肤筋膜瓣上,最后向前游离筋膜瓣。完成腮腺切除后,将前、后腮腺筋膜瓣折叠,拉紧缝合。结果：45／46例患者获得随访。术后3例分别在5个月、9个月和11个月出现轻度Frey综合征。9例术后出现耳垂暂时麻木,1～3个月后恢复感觉。下颌后凹陷不明显,无涎瘘发生。结论：改良的手术方法能完好地保留腮腺筋膜和耳大神经耳垂支、耳后支,显著降低相应并发症的发生。     

保留腮腺咬肌筋膜的腮腺切除术

目的:探讨在腮腺切除手术的同时保留并重建腮腺咬肌筋膜是否能够有效预防味觉出汗综合征的发生。方法:通过对 31例在腮腺切除术中保留、重建腮腺咬肌筋膜的患者进行术后随访,并采用咀嚼维生素C片诱导及碘 淀粉试验检测,观察术后味觉出汗综合征的发病率。结果:在调查的 31例患者中,仅有 3例患者发现有潮红和出汗现象,较传统腮腺切除术的发病率明显降低,发生率仅为 9. 69%。结论:切除腮腺时保留并重建腮腺咬肌筋膜对术后味觉出汗综合征的预防有显著效果。     

应用放射疗法治疗腮腺瘘48例分析

本文对48例腮腺瘘的病因及治疗进行分析。我们采用放射疗法治疗腮腺瘘，最大放射剂量600cGy，最小剂量为400cGy。48例患者全部治愈，放射疗法治疗腮腺瘘是一种行之有效的方法。     

The role of a temporalis fascia and muscle flap in temporomandibular joint surgery

Temporalis fascia, with a varying thickness of temporalis muscle, may be harvested as an axial flap based on the middle and deep temporal arteries and veins. The dependable blood supply, the proximity to the temporomandibular joint, and the ability to alter the arc of rotation by basing the flap inferiorly or posteriorly make this a versatile flap for lining the temporomandibular joint. In this report, the anatomy is reviewed, the harvesting technique is described, and multiple uses of the temporalis muscle-fascia flap in temporomandibular joint surgery are described.     

负压引流预防腮腺术后并发症的系统评价

目的:用系统评价方法评价负压引流在预防腮腺术后并发症方面的疗效及安全性。方法:计算机检索PubMed、Cochrane图书馆临床随机对照试验库、荷兰医学文摘、欧洲灰色文献数据库、中国生物医学文献数据库、维普数据库、万方数据库,检索时限为建库截至2013年3月10日;同时手工检索19种中文口腔医学杂志,搜集负压引流与开放式引流预防腮腺术后并发症的临床随机对照试验。2位评价者独立使用Cochrane 协作网推荐的标准对纳入文献进行偏倚风险评价并提取数据,采用Revman5.2软件进行meta分析。结果:最终纳入10项研究,偏倚风险评价显示均为中等偏倚风险。Meta分析结果显示,与开放式引流相比,负压引流能明显减少腮腺术后并发症(涎瘘/积液、血肿)的发生,提高临床综合疗效及患者的生活质量(P<0.05)。结论: 负压引流在预防腮腺术后并发症发生方面有一定的疗效和安全性,但还需要更多高质量的临床随机对照试验支持。