颊脂垫修复口内缺损1 3例报道

对13例口腔内切除肿瘤后形成组织缺损的患者采用颊脂垫修复,12例创面愈合良好,修复效果满意。颊脂垫表面于修复后第1天即被一层假膜覆盖,1周后假膜逐渐消失,2周后假膜完全消失,表面呈深红色;3周后颊脂垫表面上皮化,形成新生上皮,呈淡红色,与正常黏膜基本一致,未见面部畸形和功能障碍等并发症。1例组织瓣部分液化脱落,瘢痕愈合。     

颊脂垫在口腔软组织缺损修复中的应用

目的:评价颊脂垫在口腔软组织缺损修复中的效果。方法:17例口腔不同部位肿瘤切除后,应用颊脂垫瓣修复软组织缺损并进行回顾性分析。结果:颊脂垫在组织缺损区愈合良好,未见并发症的发生,3～4周即可见上皮覆盖,组织缺损被修复。结论:颊脂垫瓣修复口腔软组织缺损,方法简单、易行,效果满意,值得推广。     

带蒂颊脂垫在口腔肿瘤术后组织缺损即刻修复中的效果评价

目的 探讨带蒂颊脂垫瓣在口腔肿瘤术后组织缺损即刻修复中的应用效果及其适应证。方法 选择86例口腔肿瘤患者,其中,男58例,女28例,平均年龄50岁。采用带蒂颊脂垫移植即刻修复肿瘤切除术后缺损,观察术后效果和并发症情况。结果 所有病例中移植皮瓣均存活,颊脂垫瓣在9~10周内顺利愈合,未覆盖的表面形成上皮化,与正常黏膜相似。随访3个月~3年,所有患者均无明显功能障碍和面部畸形,并发症仅为3.5%。结论 带蒂颊脂垫是修复口腔组织缺损的理想材料,并发症少,是口腔肿瘤术后组织缺损即刻修复的可行选择。     

颊脂垫修复口腔肿瘤缺损的临床观察

目的 评价颊脂垫在口腔软组织缺损修复中的治疗效果。方法 8例口腔不同部位肿瘤切除后,应用颊脂垫瓣修复软组织缺损并进行回顾性分析。结果 8例颊脂垫完全成活,创面愈合良好,修复效果满意。结论 颊脂垫是修复部分口腔肿瘤术后缺损较为理想的选择。     

颊脂垫瓣转移在腭部肿瘤切除缺损中的应用研究

目的：为进一步了解带蒂颊脂垫组织瓣的应用解剖及无覆盖颊脂垫在口腔内的愈合过程。方法：作者在尸体解剖和活体观察的基础上总结颊脂垫组织瓣的解剖特点,通过对用该组织瓣修复腭部缺损的６３例平均术后４年８个月的追踪观察,并对颊脂垫移植后的愈合过程进行了组织学观察。结果：口腔内无覆盖颊脂垫移植２周后开始逐渐上皮化,６～８周完成上皮化过程,再生的粘膜呈粉红色,类似于正常的口腔粘膜,５０％的病例愈合后粘膜存在轻度瘢痕。结论：该组织瓣血供丰富,解剖恒定,易于切取,供区与受区邻近,供区隐蔽,不影响外观及功能,为口腔内软组织缺损提供了一种新的修复方法。     

008.颊脂垫在口腔重建中的应用

[英]/Baumann A …∥J Oral Maxillofac Surg.-2000,58(4) .-389～392 本文报告了颊脂垫在软硬腭缺损重建中的应用 材料和方法自1995～1998年,29例患者采用 颊脂垫作了口腔缺损的重建,年龄6～85岁,男13 例,女16例.口腔上颌窦瘘12例,其中5例直接采 用颊脂垫修复重建,7例经颊侧滑行瓣修复失败后 又作颊脂垫术.肿瘤切除后采用颊脂垫重建9例, 分别为鳞状上皮癌4例,多形性腺瘤2例,粘膜表皮 样瘤、巨细胞龈瘤和血管瘤各1例;肿瘤缺损部位5 例在硬腭,3例在软硬腭连接部,1例在颊粘膜,手术 前后均未接受放疗和化疗.3例软硬腭连接部瘘管 裂作了闭合术,1例6岁男孩采用颊脂垫关闭口腔 广泛腭裂.2例上齿槽嵴和1例下颌磨牙部位的骨 移植采用颊脂垫覆盖.1例上下颌角化囊肿切除 后,采用2个颊脂垫重建粘膜和关闭残余骨缺损. 其他的2例患者采用颊脂垫作了软硬腭重建.所有 病例术后均作了抗生素预防治疗和至少1周的流质 饮食,凡软腭肿瘤病例均作了鼻咽插管. 暴露颊脂垫的方法可选择在上颌磨牙区作前庭 水平切开,在一些肿瘤病例中,广泛的暴露已经可以 看见颊脂垫.颊脂垫经钝性剥离,用薄钩夹住转移 到缺损,扩展后作边缘缝合.软腭重建病例,移植瓣 固定到硬腭上.在局部腭粘膜下,不必作颊脂垫转 移.脂肪暴露在口腔不必覆盖. 结果最大重建骨缺损达5.5 cm×4 cm,所 有脂肪垫移植瓣均愈合,而无任何影响美观和咀嚼 功能障碍.在关闭巨大口腔上颌窦瘘时,前庭呈轻 度缩小.软腭缺损重建病例,其吞咽和语音均良好. 术后3～4周上皮生长完全,随愈合过程,脂肪出现 皱缩;愈合完全后,与局部粘膜的层次和颜色均无差 异.术后3月活检显示上皮层下为纤维结缔组织, 无脂肪组织.2例肿瘤病例术后15 d,分别在脂肪 垫中心和接近腭中缝部位继发小瘘管,经局部组织 适应而关闭.3例在下颌后磨牙和软腭部位采用了 颊脂垫的患者继发张口受限,但经张口训练4～6周 后病情改善. 讨论颊脂肪是一种特殊组织类型,它不同 于皮下脂肪.采用颊脂垫瓣修复重建缺损是一种安 全简便的方法,移植瓣生长良好并有丰富的血供,易 于接近缺损修补部位,能充分扩展,其成功率高,确 认是一种理想的口腔内缺损闭合重建的移植瓣. [陈建军陈筱玲摘陈衍恩校]     

颊脂垫瓣与颈阔肌皮瓣联合移植修复大面积颊黏膜缺损

目的 探讨用颊脂垫瓣与颈阔肌皮瓣联合移植修复大面积颊黏膜缺损的临床效果。方法 手术采用颊脂垫瓣与颈阔肌皮瓣联合移植修复9例大面积颊黏膜缺损,并通过观察术后颊脂垫瓣与颈阔肌皮瓣成活情况及张口度恢复情况来评价手术效果。结果 修复颊部黏膜侧缺损的颊脂垫瓣与颈阔肌皮瓣全部成活,张口度均能达到2.5 cm以上。结论 颊脂垫瓣与颈阔肌皮瓣联合移植是一种具有一定临床适用范围的修复大面积颊黏膜缺损的手术方法,较好地解决了因各种原因而不能行游离皮瓣修复的情况。     

颊脂垫修复口腔软组织缺损的临床观察

目的:评价颊脂垫在口腔软组织缺损修复中的治疗效果。方法:6例口腔不同部位肿瘤切除后,应用颊脂垫瓣修复软组织缺损并进行回顾性分析。结果:6例中颊脂垫完全成活,创面愈合良好,修复效果满意。结论:应用颊脂垫修复口腔内软组织缺损具有操作简便,并发症少等优点,在临床上具有较高的实用价值。     

颊脂垫移植的组织学实验研究

目的　为了解无覆盖带蒂颊脂垫组织瓣修复口腔软组织缺损愈合过程中组织学的变化。方法　人为造成缺损区 ,用无覆盖带蒂颊脂垫移植修复口腔内组织缺损 ,观察 10周。结果　发现颊脂垫口腔面 6～ 8周完全上皮化 ;脂肪组织逐步被纤维组织取代。再生的粘膜呈粉红色 ,类似于正常的口腔粘膜 ,5 0 %的实验动物愈合后粘膜存在轻度瘢痕。结论　该组织瓣解剖恒定 ,易获取 ,供区与受区近 ,可在同一切口内完成 ,供区隐蔽 ,不影响外观及功能。此方法为修复口腔软组织缺损提供了一种新方法     

带蒂颊脂垫瓣在口腔内软组织缺损修复中的应用

目的:探讨带蒂颊脂垫组织瓣在邻近口腔软组织缺损的修复中的应用。方法:11例口腔内软组织缺损修复患者,在分离颊脂垫瓣后,植入邻近软组织缺损进行组织修复。结果:本组病例中,颊脂垫瓣全部成活,3个月后全部黏膜化。结论:颊脂垫组织瓣血运丰富、操作方法简单、损伤小、成活率高,是修复其邻近软组织缺损的一种治疗方法。     

带蒂颊脂垫移植的临床应用及组织学研究

目的:了解无覆盖带蒂颊脂垫组织瓣的应用解剖及无覆盖颊脂垫移植愈合过程中组织学变化。方法:通过动物实验,对颊脂垫移植后的愈合过程进行组织学观察,并对临床采用该组织瓣修复口腔内缺损30例进行观察。结果:动物实验及临床观察发现,口腔内无覆盖颊脂垫移植后,在4～8周创面完全上皮化,8～10周再生的粘膜变得光滑,呈粉红色,类似于正常口腔粘膜。结论:该组织瓣解剖恒定,易获取,供区与受区近,供区隐蔽,不影响外观及功能。此方法为修复口腔软组织缺损提供了一种新方法。     

Free Dermal Fat Graft for Restoration of Soft Tissue Defects in Maxillofacial Surgery

Various local flaps have been used for reconstruction of developmental and post surgical soft tissue defects of maxillofacial region. They include nasolabial flap, palatal pedicled flap, buccal fat pad, temporalis muscle and fascia flap. An ideal flap for all indications is yet to be found. Our experience with free dermal fat graft in the correction of deformities associated with Parry Romberg syndrome and oral submucous fibrosis is presented.     

Histologic examination of pedicled buccal fat pad graft in oral submucous fibrosis.

PURPOSE: This report evaluates the wound healing process of buccal fat pad (BFP) grafted on a defect of the buccal mucosa for oral submucous fibrosis (OSF). PATIENTS AND METHODS: Sixteen patients with limitation of mouth opening under the diagnosis of OSF were surgically treated by cutting the fibrotic bands on the buccal mucosa (10 bilateral and 6 unilateral). The defects created were then covered by a BFP graft. The bulging BFP was trimmed postoperatively on a weekly basis until it was fully epithelialized. The specimens were stained and examined microscopically. RESULTS: Inflammatory cell infiltrate, blood vessel congestion, and fibrinous exudates covering the BFP were obvious by week 2. At week 3, blood vessel congestion and fat cell number decreased markedly. Evidence of stratified squamous epithelium with parakeratosis was seen in the margin of the BFP graft. At week 4, the number of fat cells decreased significantly and the original BFP was almost completely replaced by granulation tissue. The original BFP was fully covered by stratified squamous epithelium by week 5. CONCLUSIONS: The BFP graft has been widely used for covering exposed defects created by fibrotic band excision for the improvement of mouth opening limitation. The healing process was documented microscopically by weekly observation.     

颊脂垫瓣在覆盖颧骨内置牵张器中的临床应用

目的:探讨带蒂颊脂垫瓣在颧骨内置弧形牵张成骨术中,用于覆盖骨牵张器的临床应用可能性。方法:为1例行“右上颌骨全切术+左上颌骨次全切除术”的患者行颧骨内置弧形牵张成骨术,术中行带蒂颊脂垫瓣移植覆盖骨牵张器底面。术后延迟1周行骨牵引,共牵引3周,在此过程中观察颊脂垫瓣状况。结果:颧骨内置弧形骨牵张器被颊脂垫瓣及缺损区邻近剩余软组织完整覆盖,与口腔完全隔离。颊脂垫瓣术后状况良好,在牵引过程中,无破裂、感染,未见骨牵张器暴露及骨转移盘穿出。术后4周时,颊脂垫瓣表面实现上皮化,与正常黏膜难以区分。结论:带蒂颊脂垫瓣移植可以完成在颧骨内置弧形牵张成骨术中覆盖骨牵张器的任务,并具备简单、便捷、微创、效果可靠等优点,值得推广。     

Buccal Fat Pad in Intraoral Defect Reconstruction

The use of buccal fat pad as a graft for intraoral defects is an uncommonly reported procedure but, it has been frequently used for closure of oro-antral and oro-nasal communications. Buccal fat pad was used to reconstruct 3 medium sized defects due to tumoral resection and oro-antral communication. It was used as an unlined pedicled graft. Three cases are discussed along with anatomical aspect of the buccal fat pad. The findings support the view that the buccal fat pad is versatile, logical, convenient, and reliable method for the reconstruction of oral defects up to 4–5 cm in diameter and it healed within 4–5 weeks.     

Evaluation of Versatility and Effectiveness of Pedicled Buccal Fat Pad Used in the Reconstruction of Intra Oral Defects

Introduction

The use of buccal fat pad as a grafting source in the closure of intraoral defects has gained popularity in the last quarter of this century. Because of the ease of access and rich blood supply, its use in oral defects is an attractive concept.

Methodology

The study comprised of 8 patients with oral submucous fibrosis, 1 patient with oroantral fistula, 1 patient with verrucous hyperplasia. The acquired oral defects following resection of pathology in the oral cavity, were reconstructed with pedicled buccal fat pad. The Post operative follow up at the intervals of 1st, 7th and 15th day, followed by 1st month, 2nd month and 3rd month was done.

Results

The procedure was successful in all the patients. Healing was satisfactory with no breakdown or liquefaction necrosis post operatively. All the patients had definitive colour change at the end of 1st post operative month owing to the epithelialisation. Residual defect was present in one patient diagnosed of verrucous hyperplasia on the 1st and the 7th post operative day which subsequently healed. In 8 patients with oral submucous fibrosis post operative mouth opening was measured in and was observed to be in the range of 12–26 mm on the 1st post operative day and 34–42 mm during 3rd month post operatively.

Conclusion

The results of this study support the view that the use of buccal fat pad is a simple, convenient and reliable method for the reconstruction of small to medium sized intra oral defects.