胸锁乳突肌肌瓣修复腮腺术后缺损畸形的应用

目的:探讨腮腺肿瘤术后同期应用胸锁乳突肌肌瓣填充修复对面部凹陷畸形的预防作用.方法:对40例腮腺肿瘤病人行肿瘤及腮腺浅叶或浅叶部分切除同期行胸锁乳突肌肌瓣填充修复,观察治疗效果.结果:患者术后创面愈合良好,手术腮腺区及颈部外形良好,颈部功能正常.结论:胸锁乳突肌肌瓣修复腮腺切除术后缺损能改善术后凹陷畸形发生.     

胸锁乳突肌瓣在头颈肿瘤手术中的应用

目的　探讨以上端为胸锁蒂的乳突肌组织瓣在头颈肿瘤术区中型缺损的作用。方法　对６ 例应用胸锁乳突肌复合组织瓣修复头颈肿瘤术区缺损情况进行回顾性总结。６例病人中,１例为颞下窝肿瘤术区缺损的修复;３ 例修复腮腺颌后区缺损;１例对喉癌术区口咽侧壁修复;１例为对侧颈部术区缺损的修复。结果　５例胸锁乳突肌肌瓣的修复全部存活,１ 例胸锁乳突肌肌皮瓣的修复为延迟性坏死。结论　该肌瓣／肌皮瓣在头颈肿瘤术区中型缺损的修复有其重要意义,尤对保留面神经的腮腺颌后缺损,颅底区及咽侧壁缺损的修复意义更加明显     

美容切口及胸锁乳突肌瓣在腮腺良性肿瘤手术中的应用

目的：探讨耳屏内联合耳后发际切口及胸锁乳突肌瓣在腮腺良性肿瘤手术中的应用。方法：耳屏缘内侧切口向下，绕经耳垂，向后上再沿耳后发际斜向后下。切开皮肤达腮腺咬肌筋膜浅面，向前掀起皮瓣，之后切开腮腺咬肌筋膜暴露腮腺正常腺泡组织、并以胸锁乳突肌、二腹肌后腹和乳突为标志，寻找面神经总干，依据肿瘤位置适当分离面神经分支，切除部分腮腺及肿瘤，切取近乳突的部分胸锁乳突肌填塞创腔，术后负压引流3天～4天。行腮腺浅叶肿瘤手术共计46例，男性19例，女性27例。结果：随访4个月～60个月，46例患者切口愈合好，无涎漏及积涎，外形满意，其中2例术后短期出现轻微口角偏斜，3个月内均恢复正常。结论：耳屏内联合耳后发际切口用于腮腺浅叶良性肿瘤手术，暴露腮腺及面神经满意，较传统腮腺手术经耳屏前绕经耳垂斜向颌下的切口隐蔽美观。胸锁乳突肌瓣修复对避免术区凹陷及预防术后Frey综合征的发生有较好作用。负压置管引流较橡皮引流加压时间短，更容易让患者接受。     

美容切口及胸锁乳突肌瓣在腮腺良性肿瘤手术中的应用

目的探讨耳屏内联合耳后发际切口及胸锁乳突肌瓣在腮腺良性肿瘤手术中的应用. 方法耳屏缘内侧切口向下,绕经耳垂,向后上再沿耳后发际斜向后下.切开皮肤达腮腺咬肌筋膜浅面,向前掀起皮瓣,之后切开腮腺咬肌筋膜暴露腮腺正常腺泡组织、并以胸锁乳突肌、二腹肌后腹和乳突为标志,寻找面神经总干,依据肿瘤位置适当分离面神经分支,切除部分腮腺及肿瘤,切取近乳突的部分胸锁乳突肌填塞创腔,术后负压引流3天～4天.行腮腺浅叶肿瘤手术共计46例,男性19例,女性27例. 结果随访4个月～60个月,46例患者切口愈合好,无涎漏及积涎,外形满意,其中2例术后短期出现轻微口角偏斜,3个月内均恢复正常. 结论耳屏内联合耳后发际切口用于腮腺浅叶良性肿瘤手术,暴露腮腺及面神经满意,较传统腮腺手术经耳屏前绕经耳垂斜向颌下的切口隐蔽美观.胸锁乳突肌瓣修复对避免术区凹陷及预防术后Frey综合征的发生有较好作用.负压置管引流较橡皮引流加压时间短,更容易让患者接受.     

胸大肌肌皮瓣在晚期头颈肿瘤手术中的应用

目的探讨胸大肌肌皮瓣在晚期头颈肿瘤手术中的应用。方法应用胸大肌肌皮瓣一期修复晚期头颈肿瘤术后缺损262例（其中折叠瓣17例修复口内外穿通性缺损,20例胸大肌肌膜瓣修复口内缺损,5例胸大肌皮瓣联合游离植皮修复咽瘘,5例胸大肌肌皮瓣联合游离皮瓣双瓣修复颌面部洞穿性缺损）。舌再造62例,修复口咽53例,修复口底41例,修复口颊24例,修复颈部31例,修复下咽缺损22例,修复腮腺区缺损29例。结果262例肌皮瓣252例全部成活,8例皮瓣部分坏死肌瓣成活,2例肌皮瓣完全坏死,总的成活率为99.2%（260/262）。术后随访1～10年,所有患者术后进食、吞咽功能恢复良好,语言功能大多恢复良好。结论胸大肌肌皮瓣血供可靠,组织量丰富,且应用较灵活,可制作成肌皮瓣或肌瓣,对于晚期头颈肿瘤术后缺损是最优选择。     

胸锁乳突肌肌皮瓣修复口腔颌面部软组织缺损的临床应用

目的：探讨胸锁乳突肌肌皮瓣修复口腔颌面部软组织缺损的临床效果。方法：采用胸锁乳突肌肌皮瓣修复16例口腔癌患者术后所致软组织缺损。供区皮肤直接拉拢缝合。结果：术后切口均Ⅰ期愈合,16例胸大肌肌皮瓣全部成活,无1例发生全部或部分皮瓣坏死,移植成活率100%。患者获得满意的外观和功能。经过6个月-5年的随访,无1例肿瘤复发或远处转移。结论：胸锁乳突肌肌皮瓣制备较简单,效果可靠,具有很大的灵活性,且成活率高。可用于口腔颌面部软组织缺损的修复。     

胸锁乳突肌前缘径路甲状腺腺叶切除23例体会

目的探讨胸锁乳突肌前缘径路甲状腺腺叶切除术对甲状腺肿瘤手术治疗的临床价值。方法 对我院1998年1月-2000年12月行胸锁乳突肌前缘径路甲状腺腺叶切除术的23例甲状腺肿瘤病人进行分析。结果 全组病例手术顺利，无术中大出血及喉返神经损伤。结论 对于单侧甲状腺良性肿瘤尤其是靠近上极较大的肿瘤或再次手术的病人，行胸锁乳突肌前缘径路甲状腺腺叶切除术可减少出血及喉返神经损伤。     

放疗剂量与鼻咽癌患者胸锁乳突肌体积变化及晚反应关系

目的 探讨放疗剂量与鼻咽癌患者胸锁乳突肌体积及晚反应关系。方法 对2010-2014年间收治的38例鼻咽癌患者的胸锁乳突肌以环状软骨下缘分为上下颈部,根据CTV₂处方剂量0、54、60 Gy分为1、2、3组。放疗剂量学参数包括整条肌肉和上下颈部的D_mean、V₆₆、V₆₀。在TPS的CT图像中分别勾画疗前和疗后6、12、18个月胸锁乳突肌轮廓并计算体积,在C₃-C₄、C₄-C₅、C₅-C₆、C₆-C₇椎间盘水平分别测量并记录胸锁乳突肌前后径及左右径。颈部皮肤、胸锁乳突肌晚反应采用CTCAE4.0标准记录。两两比较采用配对t检验或非参数Kruskal-Wallis法;单因素方差分析进行组间样本率比较;采用Spearman法行相关分析。结果 疗后6、12、18个月SM体积变化之间差异有统计学意义(P=0.000)。疗后12、18个月胸锁乳突肌体积较疗前明显减小(P=0.000、0.000),且体积萎缩百分比与≥V₆₆有明显相关性(P=0.015、0.020)。疗后18个月胸锁乳突肌纤维化与上颈部V₆₀呈明显相关性(P=0.030);颈部皮肤纤维化与上颈部D_mean、V₆₀呈明显相关性(P=0.029、0.005)。结论 放疗计划优化中应尽量提高剂量均匀度,以避免颈部皮肤及胸锁乳突肌纤维化发生。     

提高头颈肿瘤术后缺损一期修复质量的体会

本文总结了头颈肿瘤术后缺损行一期修复８９例的临床经验，认为首次治疗的设计正确合理是一期修复质量的保证；全面掌握修复手段，不断提高修复技术是提高一期修复质量的关键。文中讨论了三角形皮下蒂皮瓣、颈阔肌肌皮瓣、胸锁乳突肌肌皮瓣、舌骨下肌群肌皮瓣、舌瓣、腭瓣、额瓣、颈前带状肌（皮）瓣、胸大肌肌皮瓣、前臂游离皮瓣等各自的优缺点和适应症的选择。     

整形

整形外科原则和技术在面部软组织创伤急诊处理中的应用；额颞部除皱的同时行额肌帽状腱膜瓣折叠隆额术；应用胸锁乳突肌瓣治疗晚期面瘫；应用重复扩张术修复大面积瘢痕性秃发；     

Anteriorly Based Partial Thickness Sternocleidomastoid Muscle Flap Following Parotidectomy

The anteriorly based partial thickness sternocleidomastoid (SCM) muscle flap is among the various methods described to correct parotidectomy defects, but its indications and limitations are not clearly demonstrated in several reports. This study was done to test the aesthetic outcome of this method, its indications and limitations. At Dr. Babasaheb Ambedkar Memorial hospital, Mumbai, 20 patients presenting with benign parotid tumors underwent parotidectomy. 16 underwent superficial parotidectomy and 3 underwent adequate parotidectomy, 1 had total parotidectomy. The anteriorly based partial thickness SCM muscle flap was used to correct the contour deformity and to prevent Frey syndrome. The aesthetic result was evaluated by assessing and scoring the overall appearance of the scar, the degree of symmetry of the reconstructed parotid region and the site of the donor muscle in comparison to their contralateral normal sides. The overall aesthetic appearance was good in 17 patients, and moderate in 3 patients. 17/20 patients had an overall deep satisfaction with the result. The residual hollowness following total parotidectomy defect and the poor quality of scars were the main reasons affecting the aesthetic outcome. Superficial parotidectomy through modified Blair’s incision with immediate reconstruction with anteriorly based partial thickness SCM flap allows a satisfactory aesthetic outcome and minimal donor site morbidity. Scores of the above two parameters were accessed. Patients’ satisfaction was assessed by patients questionnaire.     

Parotidectomy for benign parotid tumors: An aesthetic approach

Background/aimsThe sternocleidomastoid (SCM) partial thickness muscle flap is among the various methods described to correct parotidectomy defects, but its indications and limitations are not clearly demonstrated in several reports. This study was done to test the aesthetic outcome of this method, its indications and limitations. The technique was combined with a face lift incision to further improve the outcome.Patients and methodsAt the National Cancer Institute, Cairo University, Egypt, 23 patients presenting with benign tumors underwent parotidectomy, 19 had superficial parotidectomy and four had total parotidectomy done. The superiorly based (SCM) muscle flap was used to correct the contour deformity. The aesthetic result was evaluated by assessing and scoring the overall appearance of the scar, the degree of symmetry of the reconstructed parotid region and the site of the donor muscle to their contralateral normal sides. The overall aesthetic appearance was then calculated by the summation of the scores of the latter three parameters. Patients’ satisfaction was assessed by patients’ questionnaire.ResultThe overall aesthetic appearance was good in 17 patients, and moderate in six patients. 16/23 patients had an overall deep satisfaction with the result. The residual hollowness of the parotid following reconstruction of the total parotidectomy defect and the poor quality of scars were the main reasons affecting the aesthetic outcome.ConclusionSuperficial parotidectomy through facelift incision with immediate reconstruction with superiorly based partial thickness SCM flap allows adequate resection of most benign parotid tumors with a satisfactory aesthetic outcome and minimal donor site morbidity.     

腮腺肿瘤术中置入细胞外基质补片对Frey综合征的影响

目的：评价腮腺肿瘤术床覆盖同种异体细胞外基质补片（ECM）对术后出现Frey综合征的影响。方法：2006年6月～2007年6月，在我院接受腮腺浅叶或者全腮腺切除手术的32例腮腺肿瘤患者随机分为研究组和对照组，每组各16例。研究组在手术结束前于术床面神经各分支表面覆盖细胞外基质补片作为填充物，对照组常规处理创面，不填充任何材料。术后3个月以上两组病例均行面部碘-淀粉试验（Minor试验），并收集试验资料进行分析。结果：研究组Frey综合征的发生率为18．75％（3／16），而对照组其发生率为56．23％（9／16），两组之间比较有统计学差异（P〈0．05）。结论：腮腺肿瘤术床覆盖细胞外基质补片对术后发生Frey综合征有较好的预防作用，是一种简单有效的方法，值得推广。     

腮腺肿瘤手术20例临床分析

目的探讨腮腺肿瘤的手术方式、手术范围及预后。方法对1998--2004年间行解剖面神经的腮腺肿瘤切除术20例临床随访资料进行分析。结果腮腺浅叶切除术13例中,并发腮瘘1例;全腺叶切除术7例中,并发暂时性面瘫1例,无Frey综合征。随访10个月至6年无复发。结论腮腺良性肿瘤需行解剖面神经的浅叶及肿瘤切除术或全腮腺切除术;恶性肿瘤在面神经未受累时行保留面神经的腮腺全切术,术后辅以放疗,可以减少肿瘤复发和面瘫等并发症。     

This is how I do it. Minimizing the blood loss during flap raising in thyroidectomy

Accessory parotid gland tumors are defined as masses within salivary gland tissue located adjacent to Stensen's duct, but separate from the main body of the parotid gland. These tumors usually present as asymptomatic cheek masses. There is a temptation to excise these masses locally; however, the likelihood of injury to branches of the facial nerve is high. The best surgical approach to tumors in the accessory parotid region is via a standard parotid incision and concomitant superficial parotidectomy. Eight patients have been surgically treated with accessory parotid gland masses. Six patients had mixed tumors, one had a low grade mucoepidermoid carcinoma, and one had a localized parotitis. Our approach included a standard parotid incision, raising an anterior flap beyond the mass, and exposing the main trunk of the facial nerve, with careful tracing of all its branches. This approach to accessory parotid gland tumors is superior in that it provides a better margin of resection and minimizes functional and cosmetic deformities. Most importantly, there is less danger of injury to branches of the facial nerve. © 1993 Wiley-Liss, Inc.     

Facial nerve functionality after parotid tumors surgery

The purpose of this study is to show the connection among tumor histology, surgical treatments and facial nerve postoperative functionality. A retrospective review was conducted on 69 patients with benign and malignant parotid tumors: they underwent surgical treatment for benign and malignant parotid tumors at the Maxillofacial Division of Rome University "La Sapienza" from 1988 to 1997. In our series of patients, we performed conservative superficial parotidectomy, conservative total parotidectomy and radical parotidectomy. Tumor enucleation was reserved for those neoplasms with a limited and restricted mass. The surgical approach was based on mass extension and on histopathologic features. Our findings showed that a careful and a timely diagnosis is very important in order to select a conservative surgical treatment for benign and intermediate grade of malignancy tumors with limited dimensions. Most aggressive histological types, and large mass dimensions require a radical treatment with consequent facial nerve postoperative dysfunctions. Our experience demonstrates that this surgical approach provides a very high rate of success in the cure of tumors and a low rate of facial nerve postoperative dysfunctions.     

Identification of Facial Nerve During Parotidectomy: A Combined Anatomical & Surgical Study

To find out the most easily identifiable and anatomically consistent landmark for identification of facial nerve during parotid surgery. Ten cadaveric dissections and ten live parotid surgeries for different types of parotid tumours were done. Cadaveric dissection was performed in the Department of Anatomy and the surgeries were done in the Department of ENT and Head and Neck surgery of R. G. Kar Medical College of Kolkata. The distance of the facial nerve trunk from three most commonly used landmarks (viz., tympanomastoid suture, tragal pointer and posterior belly of digastric muscle) was measured in both cadaver and live patients. The ease of identification of the nerve trunk using each of the landmarks, particularly during live surgery was also assessed. The mean distance of the tympanomastoid suture from the facial nerve trunk was 3.5 mm (cadaver) and 3.87 mm (live surgery), the tragal pointer was found to be at a mean distance of 16.61 mm (cadaver) and 16.36 mm (live surgery) and in case of the posterior belly of digastric muscle it was 7.41 mm (cadaver) and 8.03 mm (live surgery). During live surgery the posterior belly of digastric was found to be the most easily identifiable landmark with a consistent anatomical relationship with the nerve trunk. The posterior belly of digastric muscle is the most easily identifiable and a very consistent landmark for facial nerve dissection during parotidectomy. When supplemented with the tragal pointer, accuracy in identifying the facial nerve trunk is very high, thereby avoiding inadvertent injury to the nerve trunk.     

Haemangioma of the parotid gland

A case of haemangioma of the parotid gland in a one-yearold child is described. The tumour had the characteristic soft fluctuant feel within the parotid gland, which was compressible. The tumour was removed by superficial parotidectomy with preservation of the facial nerve. The salient features of the condition are also discussed in the light of the available literature.     

Anatomical and Surgical Study to Evaluate the Accuracy of “C-M-S” Technique in Facial Nerve Identification During Parotid Surgery

Facial nerve identification is considered to be a crucial step in parotid surgery as inadvertent injury to the nerve will lead to facial paralysis. Multiple landmarks are described in literature to identify the facial nerve during parotid surgery but controversies remain as the consistency and accuracy of these landmarks vary. Numerous studies exist in literature but they fail to address a single landmark that is most reliable to identify the facial nerve during parotid surgery. The purpose of this study is to find reliable landmarks for identification of the main trunk of facial nerve during parotid surgery by evidence gathered by cadaveric dissection and intraoperative study during parotid surgery and develop a systematic approach to identify the facial nerve trunk. This prospective study included 41 cadavers (82 parotid regions) and 20 patients with parotid pathology who underwent parotidectomy. We evaluated the feasibility of our C-M-S technique to identify the main trunk of facial nerve in both anatomical and surgical study. The relationship of landmarks (tragal pointer, tympanomastoid suture, superior border of posterior belly of digastric muscle) to the facial nerve trunk was assessed and the shortest distance between them from the facial trunk was measured using a slide caliper. The measurements were compared between the anatomical and surgical study. The main trunk of facial nerve was successfully identified in all cases using C-M-S technique in both anatomical and surgical study. Distance of facial nerve trunk to tragal pointer was more in the cadaveric sample (13.04 ± 5.238 mm) compared to live patients (9.95 ± 3.967 mm) with statistically significant difference (p = 0.036). The mean distance of tympanomastoid suture and posterior belly of digastric muscle to the facial nerve trunk was similar in anatomical and surgical study with p value of 0.877 and 0.083 respectively. The tympanomastoid suture, posterior belly of digastric muscle and tragal pointer are the most useful landmarks for facial nerve identification during parotid surgery. In our study we found that the tympanomastoid suture line is the most consistent landmark present in all our cases and being closest to the facial nerve trunk in both anatomical and surgical study. Further we recommend using the “C-M-S technique” in order to locate the main trunk of the facial nerve.     

Variations of Retromandibular Vein and Its Relation to Facial Nerve Within Parotid Gland

Maxillary vein and superficial temporal vein unite to form the retromandibular vein in the parotid gland. The facial nerve lies lateral to external carotid artery and retromandibular vein. Identifying and preserving the facial nerve is the prime motto during parotidectomy. So the variations of facial nerve and the retromandibular vein should be known so as to avoid injury to both. The variations we encountered during parotid surgery will be helpful in avoiding unexpected bleeding and injury to facial nerve.