带颈横血管上斜方肌肌皮瓣即刻修复舌癌术后缺损21例报道

目的：研究以颈横动脉为蒂的上斜方肌肌皮瓣修复舌癌术后舌缺损的临床效果。方法：1994年9月-2004年4月期间，对21例经病理确诊的舌癌患者均行根治性颈清术，术中采用以颈横血管为蒂的上斜方肌肌皮瓣同期修复舌缺损。供区创面直接拉拢缝合，未行植皮。结果：21例皮瓣全部成活，仅1例出现部分坏死。术后早期再造舌外形和功能都较差，3个月-1a后，形态上出现黏膜化，语言、咀嚼和吞咽功能逐渐改善。结论：以颈横动脉为蒂的上斜方肌肌皮瓣是修复舌缺损的优良皮瓣之一．     

下斜方肌肌皮瓣修复颌面部缺损的临床应用

目的:观察应用下斜方肌肌皮瓣修复颌面部组织缺损的临床效果.方法:在对斜方肌及其血供进行显微外科学研究的基础上,利用颈横动脉浅降支设计下斜方肌肌皮瓣用于颌面部组织缺损修复.结果:5例患者斜方肌肌皮瓣全部成活,颌面外形及功能恢复基本满意.结论:应用下斜方肌肌皮瓣是修复颌面部缺损的较好方法.     

下斜方肌皮瓣和肩胛背动脉皮瓣在头颈重建中的应用

Baek等于1980年首次将下斜方肌肌皮瓣（lower trapezius myocutaneous flap，LTMF）应用于头颈部重建，随后该组织瓣逐步得到了推广和应用，并成为头颈重建常用的带蒂组织瓣之一。传统的LTMF是以颈横动脉的浅支作为血管蒂，后来的研究证实了颈横动脉的深支（肩胛背动脉）在LTMF血供中的作用，并提出了术中将该动脉包含在LTMF内的意义。晚近又出现了单纯以肩胛背动脉为血管蒂的扩展斜方肌皮瓣（extended lower trapezius myocutaneous flap，ELTMF）或肩胛背动脉皮瓣（dorsal scapular artery flap，DSAF）。ELTMF优于传统LTMF的是其皮岛设计位于斜方肌的更远端，因而有更长的血管蒂，而且组织瓣制备时无需切断斜方肌的上部肌纤维，从而大大改善了患者术后的肩功能。本文对LTMF及DSAF作一简介。     

颈横动脉为蒂的带蒂组织瓣在头颈肿瘤术后缺损修复中的应用

自上世纪70年代末以来,随着对颈横动脉及周围解剖研究的不断深入,颈横动脉为蒂的带蒂组织瓣修复头颈肿瘤术后缺损的手术方法和技巧的不断改进,以颈横动脉为蒂的带蒂组织瓣逐渐受到学者们的重视。笔者对目前国内外颈横动脉解剖学研究最新进展和以颈横动脉为蒂的带蒂组织瓣修复头颈肿瘤术后软硬组织缺损的临床研究作一综述。     

斜方肌肌皮瓣在口腔颌面外科的应用进展

斜方肌肌皮瓣用于口腔颌面缺损修复已有十几年的历史，近年来在其局部解剖和临床应用方面又有一些新的进展。本文参考近期文献，对斜方肌的应用解剖、适应证、手术方法及其优缺点进行了系统论述。     

胸大肌肌皮瓣瓣体部的改良

目的：旨在克服传统胸大肌肌皮瓣的不足，使皮瓣更薄，更长，可供皮肤面积更大，血液循环更可靠，有利于被修复处的美观与功能，方法：改进胸大肌肌皮瓣瓣体部的设计。结果：应用经改良的胸大肌肌皮瓣修复口腔颌面部大范围软组织缺损28例，取得了满意的效果，皮瓣长度可增加4cm-6cm，皮肤面积可增加10cm^2-20cm^2，皮瓣无1例坏死或部分坏死，修复后，舌体，唇颊部的外形佳，被动运动好，颜面无明显凹陷畸形，结论：改良的胸大肌肌皮瓣具有更薄，更大，更长，血液循环更可靠的优点，是修复大范围组织缺损的良好修复材料。     

延长垂直下斜方肌岛状肌皮瓣修复重建大型头颈部缺损

颈横动脉供血的延长垂直下斜方肌岛状肌皮瓣(extended vertical lower trapezius island myocutaneous flap,eVLTIMF)用于修复重建大型头颈部缺损安全可靠。该瓣制备较简单,成活率高。供区较隐蔽,可直接关闭缝合,并发症少,肩部运动受影响较小;还可制备成折叠瓣,合并其他带蒂瓣或合并肩胛骨骨肌皮瓣修复特大洞穿性缺损或下颌骨缺损。eVLTIMF在头颈部大面积缺损修复,尤其是在晚期复发性头颈部肿瘤挽救手术后巨大缺损修复重建中起着重要作用。本文对斜方肌的临床应用解剖、 eVLTIMF瓣制备及其在颅颌面、口腔颌面和颌颈区缺损修复中的应用作一阐述。     

以颈横血管为蒂的上斜方肌皮瓣整复舌癌术后缺损

自 1979年Ｍｃｃｒａｗ[1] 首次报道使用上斜方肌肌皮瓣修复头颈肿瘤术后缺损以来 ,该皮瓣在口腔颌面外科得到广泛的应用。随着对其解剖学和临床应用深入研究 ,使该皮瓣的临床应用更近完善。 1990年 9月～ 2 0 0 0年 12月 ,我们采用以颈横动脉为蒂的上斜方肌肌皮瓣修复 12例超过中线的舌癌患者 ,在切除术后的同期行舌再造术 ,获得了满意的治疗效果。一、临床资料本组病例 12例 ,女 8例 ,男 4例 ,年龄 42～ 74岁 ,平均5 6岁 ;左舌癌 8例 ,右舌癌 4例。肿块越过中线 ,舌运动不同程度受到限制 ,语言、咀嚼等功能障碍 ,肿块不同程度侵入口底 ,区…     

舌癌切除后的功能性再造术：斜方肌肌皮瓣的应用

舌癌发病率据我院统计资料占口腔癌的第一位。外科手术切除仍属当前舌癌治疗的首选手段。近十余年来 对于舌癌切除后的舌体缺损,利用不同形式和种类的肌皮瓣立即修复的工作已在国内外较为积极地进行。但是,在国内外的报道中绝大多数仍属于创面的覆盖和单纯舌体形态的恢复。作为具有复杂生理功能的口腔内的肌性器官,修复的目的主要在于最     

岛状斜方肌肌皮瓣移植后肩臂功能障碍的临床分析

目的:分析岛状斜方肌肌皮瓣制取移植后对患者肩臂功能障碍的影响。方法:对1998年5月～2003年5月回院化疗的50例行岛状斜方肌肌皮瓣修复颌面部组织缺损患者的肩臂功能情况进行主观和客观评价。采用视觉模拟评分法进行肩周疼痛程度评价,以及对患者的上肢上外展的最大角度、上肢上举功能进行评价。结果:68%的患者因行岛状斜方肌肌皮瓣修复颌面部组织缺损后出现肩臂功能障碍,并对生活及工作有造成明显影响。所有患者术侧均有斜方肌功能障碍,上肢外展及上举功能受损。结论:岛状斜方肌肌皮瓣修复颌面部组织缺损后均有不同程度的肩臂功能障碍,并对生活及工作有较大影响,应探索新的修复手段提高患者的生活质量。     

晚期口腔癌术后颊部大范围洞穿性缺损的修复

目的:评价延长锁骨上岛状筋膜皮瓣联合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌术后颊部大范围洞穿性缺损的可行性。方法:对我院2008年6月—2012年2月施行的17例延长锁骨上岛状筋膜皮瓣联合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌切除后颊部黏膜和皮肤巨大洞穿性缺损病例进行回顾分析。结果:17例患者均伴晚期口腔癌切除后的颊部软硬组织巨大洞穿性缺损,修复口腔衬里的延长锁骨上岛状筋膜皮瓣大小为10 cm×8 cm～14 cm×10 cm,修复外部缺损的延长垂直下斜方肌岛状肌皮瓣大小为15 cm×8 cm～25 cm×10 cm。所有病例均无严重并发症,随访6～34个月,9例患者无瘤生存,2例带瘤生存,6例死于局部复发及远处转移。结论:应用延长锁骨上岛状筋膜皮瓣复合延长垂直下斜方肌岛状肌皮瓣修复晚期口腔癌术后颊部大范围洞穿性缺损是一种可靠的修复方法,对于再次手术,以及放疗后病例,在一定程度上优于游离皮瓣等其他修复方法。     

锁骨上动脉岛状瓣的应用解剖

目的:为临床应用锁骨上动脉岛状瓣提供解剖学依据。方法:在10例20侧经锁骨下动脉灌注氧化铅-明胶溶液的成人尸体标本上,对颈横动脉和锁骨上动脉的分支情况、起始位置、行程、长度和管径进行观测,观察其回流静脉情况,并在尸体标本上模拟皮瓣制备。结果:颈横动脉由甲状颈干或锁骨下动脉分支而来,在锁骨中1/3上方分为深支和浅支。锁骨上动脉由颈横动脉浅支发出后行向后外,越过斜方肌浅面和锁骨的肩峰端,走行于三角肌筋膜的浅面,并逐渐发出细小分支穿过深筋膜,进入锁骨上和肩部的皮肤和皮下组织。颈横动脉起点至锁骨上动脉起点距离平均为(4.31±0.64)cm,锁骨上动脉起点至其发出分支穿深筋膜点的距离平均为(3.62±0.42)cm。颈横动脉起点处外径平均为(2.71±0.33)mm,锁骨上动脉起点处外径平均为(1.10±0.17)mm。2条锁骨上动脉伴行静脉分别回流入颈横静脉和颈外静脉。结论:以锁骨上动脉为营养血管的锁骨上动脉岛状瓣,适于转移修复口腔颌面颈部组织缺损,也可以颈横动脉为吻合血管,制作游离皮瓣。     

Combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps for the restoration of through-and-through defects of the mandible following salvage surgery for recurrent head and neck tumours

This study was performed to evaluate the outcomes of combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps for the restoration of through-and-through defects of the mandible. The subjects were six patients with recurrent malignant tumours who underwent salvage surgeries and reconstruction with combined flaps based on the transverse cervical vessels (TCVs). All patients had combined bone (four type H, one type LCL, and one type C) and extensive soft tissue defects (through-and-through defects) following salvage surgery. All tumours were removed and the complex defects restored successfully. Two patients experienced minor complications: one minor intraoral flap failure and one case of wound dehiscence at the donor site. The appearance of the face and neck was satisfactory or acceptable in all patients. No patient showed severely limited range of motion of the upper limb. The patients were followed up for 10 to 18 months. One patient was living with no evidence of disease. The use of combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps based on the TCVs may be an effective approach for the restoration of through-and-through defects of the mandible and may provide satisfactory or acceptable functional and aesthetic outcomes following salvage surgery for advanced head and neck tumours.     

Communication of the transverse cervical nerve with the marginal mandibular nerve: a previously unreported anatomical variant

Communications between the transverse cervical nerve (C2 and 3) and the cervical branch of the facial nerve have been reported. We describe a case in which the transverse cervical nerve joined the marginal mandibular branch of the facial nerve. It was found during a selective neck dissection and to our knowledge is the first report of such a communication. We discuss the clinical relevance particularly in relation to confusion with the marginal mandibular branch of the facial nerve when operating in the submandibular region.     

4种带蒂皮瓣修复35例累及口角的颊部洞穿性缺损效果比较

目的:比较4种带蒂皮瓣修复累及口角的颊部洞穿性缺损的效果.方法:35例累及口角的颊部鳞状细胞癌患者行根治性切除术后,采用4种带蒂皮瓣进行修复重建,4种皮瓣分别为交叉唇瓣(A-EF)、折叠延长锁骨上岛状皮瓣(SFIF)、折叠胸大肌肌皮瓣(PMMF)和折叠延长下斜方肌岛状皮瓣(TIMF).比较4组患者修复重建后的效果,结果...     

Location of posterior superior alveolar artery and evaluation of maxillary sinus anatomy with computerized tomography: a clinical study

Objectives: Knowledge and evaluation of the maxillary sinus anatomy before sinus augmentation are essential for avoiding surgical complications. Posterior superior alveolar artery (PSAA) is the branch of maxillary artery that supplies lateral sinus wall and overlying membrane. The aims of this study were to examine the prevalence, diameter, and location of the PSAA and its relationship to the alveolar ridge and to study the prevalence of the sinus pathology and septum using computerized tomography (CT) scans. Materials and methods: One hundred and twenty‐one CT scans (242 sinuses) from patients undergoing sinus augmentation procedure and/or implant therapy were included. Lower border of the artery to the alveolar crest, bone height below the sinus floor to the ridge crest, distance of the artery to the medial sinus wall, diameter of the artery, and position of the artery were measured; presence of septa and pathology were recorded from CT sections. Results: Prevalence of sinus septa and sinus pathology was 16.1% and 24.8%, respectively. Artery was seen in 64.5% of all sinuses and was mostly intraosseous (68.2%). Mean diameter of PSAA was found 1.3 ± 0.5 mm. No significant correlation between the diameter of the artery and age was observed. Conclusions: The results from this study suggested that CT scan is a valuable tool in evaluating presence of sinus pathology, septa, and arteries before maxillary sinus surgery. Although variations exist in every patient, the findings from this study suggest limiting the superior border of the lateral window up to 18 mm from the ridge to avoid any potential vascular damage. To cite this article:
Güncü GN, Yildirim YD, Wang H‐L, Tözüm TF. Location of posterior superior alveolar artery and evaluation of maxillary sinus anatomy with computerized tomography: a clinical study.
Clin. Oral Impl. Res. 22 , 2011; 1164–1167.
doi: 10.1111/j.1600‐0501.2010.02071.x     

用面动脉肌皮瓣修复舌及其毗邻组织缺损

目的：了解面动脉肌皮瓣修复舌及其毗邻组织缺损的临床效果。方法：以面动脉肌皮瓣修复２７例患者舌及其毗邻组织缺损，供区伤口直接拉拢缝合。观察皮瓣的成活、修复区外形及口腔与舌功能的恢复情况。结果：２５个皮瓣完全成活，２个皮瓣有部分尖端坏死，坏死部份经处理后痊愈。修复外形满意，功能恢复良好，无明显面部畸形。结论：面动脉肌皮瓣是修复舌及其毗邻组织缺损的理想材料。     

数字化三维重建技术辅助腹壁浅动脉皮瓣修复口腔颌面部缺损的应用研究

目的:探讨数字化三维重建技术在腹壁浅动脉皮瓣修复口腔颌面部缺损中的应用价值。方法:选取2018年1月至2019年10月就诊于蚌埠医学院第一附属医院口腔颌面外科拟行腹壁浅动脉皮瓣修复的口腔癌患者12例,其中男性8例,女性4例;年龄（57.4±12.6）岁。其中鳞状细胞癌10例,腺样囊性癌1例,黏液表皮样癌1例。术前均行下...