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。     

Abdominal Dermis-Fat Graft Versus Conventional Temporalis Myofascial Flap Interposition in Temporomandibular Joint Ankylosis: A Prospective Clinical Comparative Study

IntroductionTemporomandibular joint (TMJ) ankylosis is an extremely disabling condition with almost complete inability to open the jaws causing difficulty in chewing, speech, poor oral hygiene and cosmetic disfigurement. Temporalis myofascial flap still remains the most common interpositional material used; however, patients usually complain of pain during movement, unesthetic bulging in the temporal region and trismus due to scar contracture. The main aim of the study was to evaluate the efficacy of abdominal dermis-fat graft and compare it with temporalis myofascial flap as to see which of the two grafts offers more advantages and provides better postoperative results following TMJ ankylosis surgery. Materials and MethodsA total of 30 diagnosed cases of TMJ ankylosis were randomly divided into two groups of 15 patients each. All the patients underwent TMJ ankylosis release under general anesthesia followed by abdominal dermis-fat interposition in Group A and temporalis muscle in Group B. The patients were assessed for pre-operative and postoperative mouth opening (immediate and 6 month postoperative), pain during physiotherapy, donor and surgical site complications and recurrence of ankylosis.ResultsThe mean maximum inter-incisal opening in dermis-fat group was significantly higher than temporalis group both at immediate and 6 month postoperative periods (p = 0.041, 0.001). Physiotherapy was less painful in dermis-fat group than in temporalis group, and the differences in VAS scores among the 2 groups showed high statistical significance (p < 0.001). Hypertrophic scar developed at the donor site in 2 patients in dermis-fat group; however, it was located below the beltline and hardly noticeable. A total of 9 patients (4 in Group A and 5 in Group B) developed temporary facial nerve weakness, and no case of re-ankylosis was noted in either group.ConclusionDermis-fat graft in temporomandibular joint ankylosis showed better results than conventional temporalis myofascial flap in terms of postoperative mouth opening, physiotherapy and jaw function with esthetically acceptable results.     

A Retrospective Study of Temporalis Muscle and Fascia Flap in Treatment of TMJ Ankylosis

Background  

This study sought to determine the efficacy of interpositional arthroplasty with temporalis muscle and fascia flap in the treatment of unilateral temporomandibular joint (TMJ) ankylosis in adults.     

颞肌筋膜瓣在腮腺良性肿瘤切除中的应用

目的:探讨改良腮腺良性肿瘤切除术的疗效。方法:选择因腮腺良性肿瘤在我院住院患者83例,随机分为实验组44例,对照组39例。对照组按常规“S”切口手术,不行颞肌筋膜瓣修复;实验组采用改良除皱切口,转移带蒂颞肌筋膜瓣充填术区凹陷。结果:对照组局部凹陷畸形明显,Frey综合征发生率为64.10%(25/39),耳部感觉丧失的发生率为87.18%(34/39);实验组局部凹陷畸形不明显,Frey综合征发生率为11.36%(5/44),耳部感觉丧失的发生率为6.82%(3/44),经统计学处理差异有显著性(P<0.01)。结论:颞肌筋膜瓣充填术区缺损能有效降低腮腺切除术后Frey’s综合征的发生率。     

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     

Versatility of Fibula Free Flap in Reconstruction of Facial Defects: A Center Study

Purpose

To study a series of cases where vascularised fibula flap was used in various combinations of bone with muscle and skin along with its modifications for reconstruction of simple and composite defects of the facial region.

Patients and Methods

The investigators designed a retrospective study composed of patients with any pathology or defect who underwent reconstruction of maxilla or mandible with vascularised fibula free flap from 2009 to 2013. All patients were evaluated for age, gender, location and type of defect, incorporation of adjoining skin paddle and muscle, number of fibula osteotomies, ischaemia time, anticoagulant regimen, length of hospital stay, flap failure rate, dental implant rehabilitation. All patients with a minimum follow-up of 3 months post-operatively, were included in this study.

Results

The study sample composed of 30 patients with average age of 39.5 years. Immediate reconstruction was done in 86.66 % of patients. 93.1 % were mandibular reconstructions. In 40 % of patients, the fibula was double barrelled. Skin island was included with the fibula in 20 % of patients. 10 % patients underwent dental rehabilitation using implants with 6.66 % requiring distraction osteogenesis of the fibula which was not required with double barrel reconstructions. Hematoma at the recipient site was the commonest post-operative complication, although its frequency was low. A significant donor site morbidity of around 3.33 % was seen. Average stay in hospital was about 7 days. Post-operatively all patients ambulated normally and none used assisted devices. A reconstruction plate was used to achieve the ideal contour of the jaw in most cases. Aesthetic results were usually good, especially in young patients. The overall success rate was 93.33 %.

Conclusion

The fibula has many assets which make it the ideal choice for bony reconstruction of facial skeleton and adjoining soft tissue with predictable results.

     

带血管蒂腓骨组织瓣游离移植修复下颌骨缺损的临床研究

目的:评价带血管蒂腓骨组织瓣游离移植修复下颌骨缺损的临床应用价值。方法:对25例患者用腓骨瓣游离移植修复下颌骨缺损。手术采取血管吻合、坚固内固定方法恢复下颌骨形态及完整性。其中22例患者为单纯腓骨瓣移植,3例患者为携带肌皮瓣或皮瓣的腓骨瓣移植,3例患者还同期植入种植体共5枚。结果:25例患者平均随访917个月,成功率为96%。3个患者的5枚种植体均达到良好的骨整合效果,并已行上部义齿的修复。62% 的患者可正常进食,余38%的患者可进软食。96%的患者面部外形的恢复达满意或较为满意。所有患者均能正常行走,无1例出现踝关节不稳定。结论:带血管蒂的游离腓骨组织瓣具有众多其它自体骨组织瓣不可比拟的优点, 是下颌骨缺损修复重建的最佳方法之一。     

颞肌筋膜瓣联合冠突移植治疗颞下颌关节强直

目的:应用带蒂颞肌筋膜瓣联合冠突移植治疗颞下颌关节真性强直,评价其重建颞下颌关节的效果。方法:对6例颞下颌关节真性强直患者切除病变区骨质,形成骨间隙,采用带蒂颞肌筋膜瓣转移充填骨间隙和冠突切取植入构造新的“髁突”,重建颞下颌关节。手术后常规随访,评价其疗效。结果:全部病例术后随访4～28个月,开口度3.1～3.8cm,平均开口度3.5cm,效果满意。结论:带蒂颞肌筋膜瓣联合冠突移植治疗颞下颌关节真性强直具有多方面优势,是防止颞下颌关节术后复发的有效手术治疗方法。     

两种血管化游离骨肌瓣移植修复下颌骨缺损临床分析

目的:评价血管化游离髂骨肌瓣和腓骨肌瓣移植修复下颌骨缺损的临床效果,比较两种修复方法的优缺点。方法:对44例血管化髂骨肌瓣和腓骨肌瓣移植修复下颌骨缺损的病例进行回顾性研究,分析两种骨肌瓣修复后对患者面部外形与口腔功能的影响,对比供受区并发症的差异。结果:20例髂骨肌瓣,24例腓骨肌瓣均成活;二者在恢复面部外形与口腔功能上无明显差异,在移植骨长度上,两者有明显不同。结论:血管化游离髂骨肌瓣与腓骨肌瓣作为下颌骨缺损修复的常用方法,可以满足不同类型下颌骨缺损修复的需要,但根据两种骨肌瓣的特点,对于缺损长度低于8 cm,可优先考虑髂骨瓣,而缺损范围大于8 cm的可选腓骨瓣。     

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.     

Implant-Supported Restoration of a Mandibular Reconstruction With an Osteocutaneous Microvascular Free Flap: A Clinical Report

The microvascular osteocutaneous fibula free flap can provide an esthetic restoration of mandibular discontinuity defects. When the graft is favorably positioned, osseointegrated implants may be placed and a functional restoration completed. When tongue function is not compromised, the patient is able to control saliva and the food bolus and can show excellent speech. This clinical report of a patient who has undergone a mandibular resection, fibula free flap reconstruction, and implant-supported fixed prosthodontic restoration shows such treatment.     

前臂皮瓣与胸大肌皮瓣在口腔癌手术缺损修复中的应用

目的:观察前臂皮瓣和胸大肌皮瓣修复口腔癌手术缺损的治疗效果。方法:30例口腔癌患者在常规联合根治术后,随机分为A、B组,每组15例。A组采用前臂桡侧皮瓣游离移植同期修复口腔癌术后口腔颌面部缺损,B组采用胸大肌皮瓣同期修复口腔癌术后口腔颌面部组织缺损;对比两组的修复效果。结果:A组13例(86.67%)前臂皮瓣顺利成活,B组皮瓣成活率100%。A组中有6例患者虎口感觉消失、4例患者供区颜色极深或极浅;B组中有4例女性患者术后两侧乳房不对称。结论:前臂皮瓣和胸大肌皮瓣修复口腔癌手术缺损均具有较高的成功率,两种皮瓣均适用于口腔癌手术缺损修复。     

犬咽后壁瓣微血管构筑的组织学研究

目的:研究上、下蒂型咽后壁瓣术后不同时期、不同部位血管重建情况。方法:将10只杂种犬随机分为两组,每组5只,分别作上、下蒂型咽后壁瓣手术,并分别于术后即刻及术后3、7、30、90d处死,采用血管造影、常规HE切片,光镜观察及计算机图象分析等方法,比较术后不同时期、不同部位的平均血管数量和横截面积的变化。另1只犬直接处死,血管造影,取对应部位作正常对照。结果:上蒂型咽后壁瓣术后即刻无血管显影,但其血管重建较快;术后不同部位血管重建同步,分布均匀,其平均横截面积、血管数量逐渐增加,30d后和对照组相近(P>0.05)。下蒂型咽后壁瓣术后即刻蒂部有少量血管显影;术后不同部位血管重建不同步,分布不均匀,术后血管重建首先发生在瓣蒂区和瓣尖肌肉层,其平均横截面积、血管数量逐渐增加,30d时和对照组相近(P>0.05)。术后早期瓣中部和瓣尖粘膜下无血管显影,其血管重建较慢,瓣中部一直血管稀少,90d时才和对照组相近。结论:上、下蒂型咽后壁瓣术后均能建立和术前相近、分布均匀的血管网。     

血管化肋骨组织瓣游离移植修复下颌骨缺损10例临床分析

目的:总结分析血管化游离肋骨瓣在下颌骨缺损中的应用体会。方法:回顾性分析10例于我科诊治并行肋骨瓣移植修复下颌骨缺损的病例资料,对其修复方法及治疗效果进行总结。结果:10例血管化游离肋骨瓣全部成活,下颌骨外形及功能恢复较好,仅1例出现术后咬合关系错乱。结论:对于下颌骨节段性缺损的修复,血管化游离肋骨瓣是一种较好的方法。     

血管化腓骨瓣修复涉及髁突下颌骨缺损的临床应用

目的:对累及髁突的不同类型下颌骨缺损采用游离腓骨瓣修复的方法、经验进行总结。方法:2001年10月-2004年10月,53例累及下颌升支上部的颌骨良性病损,行下颌骨切除后采用游离腓骨瓣进行下颌骨重建,分别采用了腓骨代替髁突法(30例)、游离髁突法(7例)及保留髁突法(16例)3种方法进行下颌骨缺损修复重建。分析总结临床方法经验,并对患者术后外形和功能进行临床评价。结果:本组血管化游离腓骨瓣移植成活率98.1%(52/53);41例患者术后随访,进行了临床检查及外形、功能评价,经Fisher检验,腓骨替代髁突组、游离髁突组及保留髁突组患者在术后外形和进食、语音功能上无显著差别。结论:3种不同髁突处理方法进行游离腓骨瓣下颌骨缺损重建,在临床上实用可行,可依据患者病损的具体情况选用。     

腓骨肌(皮)瓣一期修复下颌骨缺损

目的：总结应用腓骨肌（皮）瓣一期修复下颌骨缺损的经验.方法：根据7例患者下颌骨缺损的部位和特征,对其腓骨进行截骨和塑形,以恢复其下颌骨的形态和功能,并以大钛板进行坚固内固定.结果：7例以腓骨肌（皮）瓣修复下颌骨缺损患者全部成功,伤口愈合良好.结论：腓骨肌（皮）瓣可根据下颌骨缺损的部位和形态进行截骨和塑形,是用来修复下颌骨缺损的一种理想的方法.