颞肌筋膜瓣修复上颌骨缺损临床观察

目的：评价颞肌筋膜瓣修复上颌骨缺损的效果。方法：8例上颌骨肿瘤行上颌骨切除术后,采用颞肌筋膜瓣即刻修复,术后6～30个月随访,对面部外形、张口度、语言清晰度进行观察评价。结果：7例伤口Ⅰ期愈合,1例伤口感染,所有组织瓣成活。7例面形满意,7例语言清晰度Ⅰ级,8例张口度正常或轻度受限。3个月后,组织瓣色泽、形态均接近对侧组织。供瓣区轻度凹陷。结论：颞肌筋膜瓣修复上颌骨缺损是一种面容、语言和形态恢复较为理想的方法、成活率高、安全可靠。     

颞肌筋膜瓣在上颌骨缺损治疗中的应用

目的:研究应用颞肌筋膜瓣修复上颌骨缺损,并对其颌面外形和功能进行评议。方法:1999年10月-2004年4月,11例病人因上颌骨肿瘤进行部分切除,术后即刻采用颞肌筋膜瓣修复重建。结果:11例组织瓣全部成活,与周围创口愈合良好。随访3月～4年,患者语言、吞咽、呼吸功能恢复满意。少数患者术后张口度和咀嚼效率欠佳。结论:颞肌筋膜瓣修复上颌骨缺损安全可靠,简单易行。     

颞肌筋膜瓣修复口腔颌面部缺损的临床研究

目的应用颞肌筋膜瓣修复口腔颌面部缺损８例。方法 根据缺损大小和部位设计全部或部分颞肌筋膜瓣,将其转移修复口腔颌面部缺损,５例修复上颌骨缺损,２例修复下颌骨升支前缘及咽侧壁,１例修复上颌骨及眼眶。结果 本组８例颞肌筋膜瓣全部成活,缺损处组织充填丰满,病人可正常进食和言语,外观满意。结论颞肌筋膜瓣是口腔颌面部缺损理想的修复材料。     

带蒂颞肌颅骨瓣修复上颌骨上份的缺损

目的探讨带蒂颞肌颅骨瓣修复上颌骨上份缺损的优缺点。方法对6例上颌骨缺损的患者,用带蒂颞肌颅骨瓣修复上颌骨上份（眶底）缺损,同时封闭口鼻瘘。结果术后患者的伤口均一期愈合,皮瓣成活,术后随访12个月,其面部外形满意,能够正常进食,进食时无食物从鼻腔返流,语音清晰。结论应用带蒂颞肌颅骨瓣重建上颌骨上份（眶下区）缺损,术后患者上颌骨外形和语音恢复正常,值得推广应用。     

颞肌瓣修复上颌骨及腭部缺损的语音功能评价

目的　分析颞肌瓣即刻修复上颌骨及腭部术后缺损患者的语音功能恢复情况。方法　通过对 19例应用颞肌瓣修复上颌骨及腭部缺损的患者进行腭咽闭合功能、头颅腭咽侧位X线片测量和语音清晰度测定 ,分析评价颞肌瓣即刻修复上颌骨及软腭部术后缺损患者的语音功能恢复情况。结果　 19例患者中 ,有 15例 (78.0 0 % )为完全腭咽闭合 ,3例 (15 80 % )为边缘性腭咽闭合 ,1例 (5 2 6 % )为腭咽闭合不全 ,平均语音清晰度为 94 3% ,接近正常人语音清晰水平。结论　颞肌瓣修复上颌骨及腭部缺损能够较好地重建口腔发音结构 ,维持腭部功能 ,较好地恢复术后语音功能     

颞肌瓣在口腔颌面缺损修复中的应用

本文总结了应用颞肌瓣修复口腔颌面部缺损的６例经验。其中上颌骨缺报修复２例，１例为扩大的上颌骨切除术，１例为上颌骨部分切除木；耳后乳突区２例；颊粘膜和面部缺损各１例。６例颞肌瓣全部成活，３例口内修复之颞肌瓣表面４～６周均出现良好的上皮化。除１例术后出现轻度张口受限外，未发现其它并发症。作者对颞肌瓣的应用解剖要点和手术方法进行了描述，并对颞肌瓣的发展概况、优缺点及注意事项进行了讨论。     

带蒂颊脂垫衬里与颞肌筋膜瓣联合钛网重建上颌骨缺损

目的 探讨应用带蒂颊脂垫衬里与颞肌筋膜瓣联合钛网对上颌骨缺损行闭合式三维重建方法的可行性。方法 11例上颌骨肿瘤患者,8例行上颌骨次全切除,其余3例行上颌骨全切除,术中同期应用带蒂颊脂垫衬里和颞肌筋膜瓣联合钛网构筑上颌骨各壁,恢复上颌骨外形。结果 所有病例组织瓣全部成活,带蒂颊脂垫瓣和颞肌筋膜瓣术后4-6周上皮化,恢复鼻腔、腭部、牙槽及牙弓外形。张口度2.5-4 cm,进食时无食物从鼻腔返流,发音恢复良好,对面容外形修复效果较满意。3例上颌骨全切除的患者术后随访无复视。结论 采用带蒂颊脂垫衬里与颞肌筋膜瓣联合钛网闭合式重建上颌骨缺损的方法,可恢复患者的外形和功能,术式简单适用、风险小。     

冠突颞肌瓣联合血管化腓骨肌皮瓣修复全上颌骨缺损

目的：探讨冠突颞肌瓣联合血管化腓骨肌皮瓣修复全上颌骨缺损的手术方式及临床价值。方法 ：收集2例上颌骨全切术后面中部缺损畸形（James BrownⅢb类）患者,采用冠突颞肌瓣联合血管化腓骨肌皮瓣行全上颌骨重建,术前应用Surgicase 5.0（Materialise,Belgium）软件进行手术规划,对手术方式及术后效果进行预测分析。术中以冠突颞肌瓣旋转修复眶底,冠突大小分别为3.5 cm×1.5 cm及4.0 cm×1.6 cm;以2段式腓骨塑形修复牙槽突,腓骨长度分别为32.51 mm、27.36 mm及71.82 mm、38.74 mm;以腓骨肌皮瓣携带皮岛修复面中部软组织缺损。结果：术中检查冠突颞肌瓣血供良好,术后腓骨肌皮瓣均成活,创口一期愈合。分别随访5个月和6 a,无复视、睑外翻及眼球突出,无涎瘘、下唇麻木等并发症,开口度正常。CT检查眶底及牙槽突重建形态良好。结论：冠突颞肌瓣联合血管化腓骨肌皮瓣发挥了不同组织瓣的优势,是全上颌骨缺损重建的良好选择。     

上颌骨切除后即刻修复的研究

本文研究上颌骨肿瘤切除术后用带蒂组织瓣即刻修复的方法,并对瓣的解剖学基础及手术应用优缺点进行讨论说明。结论带组织瓣是即刻修即上颌骨缺损的较好办法;颞肌筋膜瓣是修复较大面积的上颌骨缺损的最简便有效的方法之一。     

创伤性颞下颌关节强直不同手术方法的比较研究

目的 探讨创伤性颞下颌关节强直伴内侧髁突残存的不同手术方法及疗效.方法 遵义医学院附属口腔医院2008年～2013年收治的创伤性颞下颌关节强直伴内侧髁突残存的患者18例,其中10例行关节间隙成形+喙突游离移植+颞肌筋膜瓣治疗,8例行外侧成形+颞肌筋膜瓣治疗.通过临床及CBCT随访比较两种方法的临床治疗效果,对术后复发率、咬合、面型的影响以及最大开口度变化进行统计学分析.结果 术后随访12～24月,关节间隙成形+喙突游离移植+颞肌筋膜瓣组术后复发患者2例(2/10),外侧成形术+颞肌筋膜瓣组术后无复发病例.外侧成形术+颞肌筋膜瓣组术后患者咬合、面型及最大开口度与关节间隙成形+喙突游离移植+颞肌筋膜瓣组比较有显著性差异(P＜0.05).结论 在内侧残存的髁突及关节盘可保留的情况下,采用外侧成形术+颞肌筋膜瓣是治疗创伤性颞下颌关节强直的理想术式.     

Temporalis muscle flap for immediate reconstruction of maxillary defects: review of 39 cases

This study evaluated the advantages and complications associated with immediate reconstruction of maxillary defects after maxillectomy and the relationship between defect tissues classification and postoperative results after using the temporalis muscle flap. In this retrospective study, the records of 39 patients who underwent immediate reconstruction surgery using temparolis myofascial flap following maxillectomy from April 1989 to February 2009 were reviewed. Demographic data, features of the disease, follow-up, outcome and complications were analysed. Patients were classified into three groups, to ascertain the influence between defect classification and functional results, aesthetic outcomes and complications in each group. Of the 39 cases, all tissue flaps survived. 5 patients underwent postoperative radiotherapy, which did not seem to influence the outcome of the reconstructive procedure. There was one case of oroantral fistula, which could easily be obturated with the prosthesis. One patient developed haematoma in the donor site 5 days after surgery. Postoperative speech was good, facial appearance was normal and ocular function remained unchanged. Postoperative aesthetic and functional results were satisfying. The temporalis muscle flap can be considered as a first-line reconstructive option for maxillary defects. Acceptable functional and aesthetic outcomes can be expected in high rates.     

上颌骨大型缺损的个体化三维闭合式功能性重建

目的：介绍一种以CAD／CAM快速原型模型预成钛网支架，结合前臂皮瓣或串联腓骨肌瓣行闭合式上颌骨缺损三维重建的新方法。方法：自2000年3月起，对10例上颌骨因肿瘤及外伤后缺损的病例，分别行上颌骨次全切除4例(Ⅱ类缺损)，全上颌骨切除6例(Ⅲ类缺损)。术前均以三维CT及快速原型技术预成实体模型，并通过CAD／CAM将健侧上颌骨复制到患侧缺损处，在模型上精确塑形钛网。8例前臂皮瓣与2例前臂串联腓骨肌瓣覆盖钛网以重建上颌骨，关闭口鼻腔。结果：10例上颌骨缺损病例经6—24个月随访观察，皮瓣除2例因术后放疗部分坏死外全部成活，面部外形满意。除1例于术后9个月眶外侧壁复发外，其余经CT或MRI检查证实，肿瘤未见复发。张口度2、5—4cm，进食时无食物从鼻腔返流。语言较为清晰，其清晰度经语音工作人员评定，术前术后趋于一致。其中6例钛网支架构筑外形的患者已行可摘局部义齿修复，能进普食。经TekscanⅡHe力测定仪术前术后对比研究，发现能在一定程度上恢复患者原有的咬合力。3例上颌骨全切的病例修复术后6—12个月经鼻咽内窥镜检查，发现钛网内衬有正常软组织覆盖。结论：我们设计的这种以CAD／CAM快速原型模型预成钛网支架、结合前臂皮瓣或串联腓骨肌瓣闭合式三维重建上颌骨缺损的新方法，使术后患者上颌骨外形和口腔功能令人满意，值得推广应用。     

Conventional prosthetic rehabilitation after free flap reconstruction of a maxillectomy defect: A clinical report

Microvascular free flap reconstruction of maxillectomy defects has been advocated as a more desirable treatment option than conventional prosthetic rehabilitation. Free flap reconstruction can successfully separate the oral and sinonasal cavities, but the reconstructed defect may not improve the treatment outcome when compared with conventional prosthetic rehabilitation of a nonsurgically reconstructed defect. In this report, the prosthetic management of a patient who underwent immediate microvascular free flap reconstruction of a unilateral maxillectomy defect is described, and the issue of surgical versus nonsurgical reconstruction is discussed.     

颞肌瓣在口腔肿瘤手术后缺损的修复

目的　口腔颌面部恶性肿瘤根治术后导致的功能障碍给患者带来了生活中的不便,颜面部的畸形使患者对生存丧失勇气。过去国内外学者采用胸大肌等带蒂或游离移植术来修复创面,但终因手术较为复杂等使推广应用受到某些限制。为寻找简单实用的修复方法,我科使用颞肌瓣修复用口腔颌面部恶性肿瘤术后造成的颌面畸形。方法　对12例口腔恶性肿瘤患者,实行肿瘤切除后颞肌瓣即刻修复。结果　全部病例转移修复的颞肌瓣均存活,伤口痊愈,口腔内洞穿缺损消灭,颞肌瓣表面在术后二周出现粘膜化。结论　颞肌瓣修复口腔颌面部恶性肿瘤术后引起的畸形是可行的,且其方法简单易操作,对患者创伤小,转移皮瓣存活率高。     

游离髂骨加前臂皮瓣修复上颌缺损（附4例报告）

目的：通过4例上颌骨肿瘤行上颌骨低位切除后缺损的修复,评估上颌重建的效果。方法：采用游离髂骨加前臂皮瓣移植上颌缺损。结果：4例患者的游离髂骨及前臂皮瓣均成活,经术后半年随访,移植之髂骨及前臂皮瓣生长良好。结论：游离髂骨加前臂皮瓣上颌低位重建的较满意的方法,它可恢复患者的面形及语言和吞咽功能,解决患者的生理和心理负担。     

Temporalis muscle flap for craniofacial reconstruction after tumor resection

Temporalis muscle flap provides a good solution for the reconstruction of craniofacial defects after tumor resection. Nine patients with complicated defects located at the upper two thirds of the face, anterior cranial base, or mastoid region are presented. Five patients had orbital exenteration, two with total maxillectomy and two with anterior craniofacial resection. Temporalis muscle flap provided profuse well-vascularized tissue for the obliteration of orbital exenteration and total maxillectomy cavities and coverage of surface defects. Cranial, oral, and nasal spaces were separated successfully in all patients. Temporalis muscle flap is a very reliable technique with low complication rates and few donor site problems. This safe and technically easy flap can be preferred for the reconstruction of craniofacial defects after ablative tumor surgery, especially in older and debilitated patients.     

应用游离腓骨-(*母)长屈肌筋膜瓣修复上颌骨缺损

目的　探讨应用游离腓骨 长屈肌筋膜瓣修复上颌骨缺损的可行性。方法　 2 0 0 2年8月～ 2 0 0 3年 8月完成游离腓骨 长屈肌筋膜瓣行上颌骨缺损修复 9例 ,分析上颌骨缺损的原因、范围、所采用腓骨瓣的设计、受区血管、游离瓣成活情况及术后并发症。结果　本组中 4例为双侧上颌骨缺损 ,所采用的游离腓骨 长屈肌筋膜瓣中 ,腓骨长度 4 5～ 11 5cm(平均 7 7cm) ,肌筋膜瓣修复口内缺损面积为 (7～ 12 )cm× (4～ 7)cm ,腓骨的截骨段数为 1～ 3(平均 2 1) ,血管蒂长度为 8～ 11cm(平均 9 3cm) ,1例游离瓣术后出现血管危象 ,经抢救获得成活 ,长屈肌筋膜瓣全部成活 ,无一例出现供区并发症 ,患者的外形和功能在术后随访期内均得到不同程度的恢复。结论　游离腓骨 长屈肌筋膜瓣克服了传统游离腓骨复合瓣存在的缺点 ,是上颌骨缺损修复的可靠方法 ,值得进一步研究和应用。     

Prosthodontic guidelines for surgical reconstruction of the maxilla: a classification system of defects.

Surgical reconstruction of maxillectomy defects has been described as an alternative to prosthetic rehabilitation to close the oral cavity. Advancements in microvascular surgical techniques require comprehensive treatment planning guidelines for functional rehabilitation. This retrospective study evaluated acquired maxillectomy defects after surgical reconstruction and/or prosthodontic rehabilitation in an attempt to establish surgical and prosthodontic guidelines that could be organized into a classification system. Forty-seven consecutive patient treatments of palatomaxillary reconstruction at a single facility, The Mount Sinai Medical Center (New York, N.Y.), were reviewed. All patients were rehabilitated with a tissue-borne obturator, a local advancement flap, a fasciocutaneous free flap, or a vascularized bone-containing free flap. Palatomaxillary defects were divided into 3 major classes and 2 subclasses. The aim of this defect-oriented classification system was to organize and define the complex nature of the restorative decision-making process for the maxillectomy patient.