Omega incision face-lift approach and SMAS rotation advancement flap in parotidectomy for prevention of contour deficiency and conspicuous scars affecting the neck

To overcome the disadvantages after the surgical removal of tumours of the parotid gland, especially the depressed facial deformity and conspicuous cervical scar formation subsequent to parotid surgery, we have concentrated on omega face-lift incision in combination with an SMAS rotation advancement flap for the last several years using a lazy omega incision. Nine patients (3 male and 6 female) ranging in age from 43 to 68 years (mean age: 56.3 years) fulfilled the selection criterion of having a clinically benign discrete parotid lump with a benign preoperative fine needle cytology result. Parotidectomy was performed using the modified omega face-lift incision in conjunction with the rotation advancement SMAS flap. All patients underwent follow-up every 3 months in the first year. During the follow-up, the patients were specifically asked about their satisfaction with the post-operative appearance and whether they would consent to the operation again. The vascularized SMAS rotation advancement flap is clinically simple to perform and provides satisfactory cosmetic and functional results in patients undergoing conservative parotidectomy. There are no drawbacks in the use of modified face-lift incision to remove tumours of the parotid gland.     

SMAS及胸锁乳突肌瓣在腮腺肿瘤外科中的应用

目的评价面部表浅肌肉筋膜系统(Superficial Musculoaponeurotic System,SMAS)及胸锁乳突肌瓣在腮腺肿瘤外科中应用的临床价值。方法 43例腮腺肿瘤患者,随机分为2组,术中均采用保留面神经和耳大神经,实验组肿瘤切除后以SMAS及胸锁乳突肌瓣覆盖填塞缺损术区,对照组直接关闭创口。结果两组患者均达临床Ⅰ期愈合,无涎瘘发生。实验组Frey's综合征发生率及面部凹陷畸形满意度均低于对照组(P<0.05)。结论将SMAS及胸锁乳突肌瓣应用于腮腺肿瘤外科中,有效抑制了Frey's综合征发生率,且远期美容效果较好,具有较高临床应用价值。     

SMAS folded flap and allograft dermal matrix repairing parotid bed following parotidectomy to prevent facial deformity and Frey''''s syndrome

PURPOSE:This study evaluates the outcome of superficial musculoaponeurotic system(SMAS) and allograft dermal matrix(ADM) in preventing facial deformity and Frey's syndrome following parotidectomy.METHODS:Forty-six patients with benign parotid tumors were randomly assigned to 4 groups.The control group consisted of 12 patients who underwent a total parotidectomy;The AMD group consisted of 10 patients who underwent a total parotidectomy and underwent intraoperative placement of ADM within the parotid bed;SMAS group consisted of 11patients who underwent a total parotidectomy and SMAS folded flaps to repair parotid bed;and SMAS plus AMD group consisted of 13 patients who underwent a total parotidectomy and intraoperative placement of ADM to repair parotid bed with SMAS folded flaps.All 46 patients were evaluated via a short questionnaire regarding perception of a facial contour deformity,Frey's syndrome,modified Minor's starch-Iodine test(MSIT) ,and clinical examination.RESULTS:Twelve months of follow-up was conducted after the treatment,the rates of satisfaction with the post-operative facial contour were 33.3%(4/12) ,40.0%(4/10) ,91.9%(10/11) and 100%(13/13) respectively in the control group,AMD group,SMAS group and SMAS plus AMD group,and the difference between the SMAS plus AMD group and the former two groups was statistically significant(P< 0.05) .The incidences of objective Frey's syndrome by MSIT were 50.0 %(6/12) ,20.0%(2/10) ,27.3%(3/11) and 7.7%(1/13) respectively,and the difference between the SMAS plus AMD group and the control groups was statistically significant(P<0.05) .CONCLUSION:The SMAS folded flap is clinically simple to perform,which can prevent depressed facial deformity.Combination of SMAS folded flap and ADM can reduce the incidence of Frey's syndrome in patients undergoing parotidectomy.     

解剖面神经颧支在腮腺切除术中的临床应用

目的：总结解剖面神经颧支在腮腺良性肿瘤切除术中的临床应用。方法：采用经典的面部除皱手术切口,在腮腺嚼肌筋膜下翻瓣,先在耳屏前颧弓下解剖显露面神经的颧支,然后沿该支显露面神经的颞面干及面神经总干,再根据肿瘤的位置沿总干选择性地解剖面神经颈面干及各分支,行肿瘤及腮腺部分切除术。最后采用蒂在上方的胸锁乳突肌肌瓣转移填塞腮腺切除后的凹陷区,避免了常规术式术后耳前区的凹陷畸形。结果：采用该术式对19例患者行腮腺良性肿瘤切除术,所有手术均顺利完成,术后随访3～4年,患者面部疤痕不明显,外形恢复良好,面神经损伤均完全恢复。结论：本术式更易于显露和保护面神经,改善术后面部畸形。     

两种手术切口治疗腮腺肿瘤的对比研究

目的介绍一种腮腺肿瘤切除的改良式手术切口,并与传统方法进行临床对比。方法改良的腮腺切除术采用耳屏前面部除皱切口及耳后延续入发髻内切口,在嚼肌筋膜(SMAS)下翻瓣,减少了术后Frey综合征的发生;先解剖面神经总干减少了周围支的损伤,暴露面神经总干后,根据肿瘤的位置,选择性解剖面神经颈面干行腮腺部分切除术,保护腮腺的部分功能;采用蒂在上方的胸锁乳突肌填塞局部减少了术后畸形。结果应用传统术式的36例患者,38.8%出现面神经功能损害,16.2%出现涎瘘,8.3%出现Frey综合征;应用改良术式的6例患者中,无1例出现涎瘘及面神经损伤,随访3～6个月无1例出现Frey综合征,并且局部凹陷轻微,面容美观。结论改良式手术方法切口隐蔽,容易操作,不易损伤面神经周围支,术后并发症少。     

腮腺切除改良术式治疗腮腺良性肿瘤

目的了解腮腺切除改良术式治疗腮腺良性肿瘤的临床疗效。方法采用腮腺切除改良术式共治疗35例腮腺良性肿瘤患者，术式改良内容包括除皱术手术切口、解剖保留耳大神经后支、胸锁乳突肌肌瓣填塞术区、术后负压引流。结果本组35例患者术后出现Frey综合征者2例，发生涎瘘者1例，出现暂时性面神经功能减弱者7例，术侧耳垂和耳廓背部皮肤感觉均暂时性减弱，术后美容效果满意率100％。结论腮腺切除改良术式治疗腮腺良性肿瘤既可取得良好的美容效果，又可降低并发症发生率，值得在临床推广。     

Facelift approach with a hybrid SMAS rotation advancement flap in parotidectomy for prevention of scars and contour deficiency affecting the neck and sweat secretion of the cheek

Tumors of the parotid gland are generally be removed by the standard external bayonet-shaped incision approach without reconstruction of the parotid bed. The disadvantage of this approach is frequently an obvious scar affecting the neck and a conspicuous hollow contour around the angle of the mandible in addition to a sweat secretion of the cheek (Frey syndrome). To overcome these disadvantages, especially the facial depressed deformity subsequent to parotid surgery, during the last several years, the author has concentrated on facelift incision used in combination with a hybrid SMAS rotation advancement flap. Twelve patients (7 male; 5 female) ranging in age from 32 to 73 years (mean age, 57.8 years) fulfilled the selection criterion of having a clinically benign discrete parotid lump with a benign preoperative fine-needle cytology result. Parotidectomy was performed using the modified facelift incision in conjunction with the rotation advancement hybrid SMAS flap. All patients were followed up every 3 months during the first year. During follow-up, the patients were specifically asked about their satisfaction with their postoperative appearance and whether they would consent to the operation again. The vascularized hybrid vicryl mesh/SMAS rotation advancement flap is clinically simple to perform and provides satisfactory cosmetic and functional results in patients undergoing conservative parotidectomy and prevents the gustatory sweating. There are no drawbacks to the use of the modified facelift incision to remove tumors of the parotid gland.     

胸锁乳突肌肌瓣与美容切口在腮腺肿瘤术中的应用

目的 探究胸锁乳突肌肌瓣与美容切口在腮腺肿瘤术中的手术效果,以及患者满意度的情况。 方法 研究对象选取为2015年1月~2017年6月我院收治的74例腮腺肿瘤患者,采用数字表法随机分为观察组和对照组各37例,两组患者均沿耳屏缘内侧向下做美容切口并切除肿瘤,观察组在切除肿瘤后将胸锁乳突肌肌瓣修复术区缺损,对照组不做任何修复处理,对比两组患者的术中出血量、手术时间、住院时间等手术指标,对比两组患者的术后并发症情况,并采用满意度问卷调查两组患者的手术满意度。结果 两组患者的术中出血量、手术时间、住院时间对比无显著差异（P＞0.05）;两组患者术后暂时性面瘫、涎瘘、耳垂麻木发生率对比无显著差异（P＞0.05）,观察组术区凹陷畸形、Frey综合征发生率显著低于对照组（P＜0.05）;观察组患者满意度为94.6%（34/37）,显著高于对照组的67.6%（25/37）,差异具有统计学意义（P＜0.05）。结论 胸锁乳突肌肌瓣修复腮腺肿瘤术后缺损不会影响手术时间及术中出血量,同时可有效减少术后并发症的发生,提高患者的手术满意度,值得在临床上应用和推广。     

A combined superficial inferior epigastric artery flap and vascularized iliac crest flap in the reconstruction of extended composite defects of the posterior mandible and adjacent soft tissue: first clinical results

The technique of posterior facial reconstruction using a combination of a superficial inferior epigastric artery (SIEA) flap and a microvascular iliac crest flap (deep circumflex iliac artery (DCIA) flap) is described. 12 cases are reported. The patients had unilateral squamous cell carcinoma of the posterior mandible affecting parts of the soft palate and tonsil region or the posterior cheek. In all patients unilateral neck dissection, resection of the posterior and lateral mandible, was performed. Reconstruction was carried out during primary surgical therapy, followed by postoperative radiotherapy. A flap combination of a SIEA and a DCIA flap was used. There were no problems with pedicle length or anastomoses. There was no flap loss or severe postoperative complications. All patients had good aesthetic and functional results. One patient had distant metastases 2 years postoperatively. All other patients were free of tumour relapse or metastases within 12-58 months of follow up. The SIEA flap and vascularized iliac bone flap combination is useful in reconstructing the posterior face. The iliac bone flap is well suited for posterior mandible reconstruction and the SIEA flap for reconstruction of the soft palate, lateral pharyngeal wall and cheek. Both flaps are harvested from the same donor site.     

胸锁乳突肌瓣在腮腺肿瘤切除术中的应用

目的:探讨腮腺手术中同期行胸锁乳突肌瓣转移术修复面部凹陷畸形的效果,及其对味觉出汗综合征(Frey综合征)预防作用。方法:对29例腮腺肿瘤病人行肿瘤加腮腺深叶或全叶切除术,其中18例同期行蒂在上的胸锁乳突肌瓣转移修复术为研究组;剩余11例,只行腮腺肿瘤切除术为对照组。术后随访观察治疗结果。结果:两组术后切口均I期愈合。经过12¹8个月随访,研究组侧面外形良好,颈部外形及功能正常,未出现Frey综合征。对照组,面部外形较差,5例出现Frey综合征。结论:胸锁乳突肌瓣转移术能明显改善腮腺肿瘤术后面侧部畸形,同时能有效降低味觉出汗综合征发生率。     

Sternocleidomastoid myocutaneous flap for intraoral reconstruction after resection of oral squamous cell carcinoma.

PURPOSE: The sternocleidomastoid (SCM) myocutaneous flap remains an important tool in head and neck reconstruction. This article retrospectively reviews 40 consecutive SCM myocutaneous flaps used for the reconstruction after resection of oral squamous cell carcinoma with respect to reliability and complications. PATIENTS: From 1987 to 1997, 40 patients underwent SCM myocutaneous flap reconstruction of the oral cavity. The age and gender of the patients, site of primary tumor TNM stage, type of associated operation, and clinical course were analyzed. RESULTS: In 8 cases, partial epithelial loss over the skin paddle occurred with survival of the muscle and at least some of the dermis. Unilateral supraomohyoid neck dissection (SND) was performed in 11 cases, and unilateral functional neck dissection, which preserves SCM and/or internal jugular vein and/or accessory nerve, in 16 cases. Pathologically positive nodes were recognized in 14 of these 27 neck dissection cases; in 11 of these 14 cases, the neck lesion was controlled. CONCLUSION: The SCM myocutaneous flap appears to be simple to use and useful for reconstruction of the defect after resection of oral carcinoma, and the indications for this flap will be extended in accordance with the recent increases in the number of supraomohyoid and functional neck dissection cases.     

The posteriorly based platysma flap in oral and facial reconstruction: A case series.

PURPOSE: The purpose of this study was to assess the reliability and use of the posteriorly based platysma flap for oral and facial reconstruction. PATIENTS AND METHODS: This case series consists of 7 patients who were reconstructed with a posteriorly based platysma flap for various tumor resection defects of the oral and facial region. The flaps were monitored for complications, including skin loss and ischemia in the postoperative period. RESULTS: Three of the patients (43%) in this study had no complications. Three patients (43%) had some skin sloughing, but the underlying muscle remained viable and mucosalized normally. One patient (14%) had 40% flap loss of the distal end, possibly due to vascular compromise that occurred during a concomitant neck dissection. CONCLUSION: The posteriorly based platysma flap is a reliable reconstruction option for defects in the facial and oral region. If skin sloughing occurs, it is usually inconsequential for intraoral reconstruction as the underlying muscle remains viable and undergoes epithelialization.     

Surgical resection of clinically benign tumours in the maxillomandibular deep lobe of the parotid gland via sternocleidomastoid muscle–parotid space approach

This article reports the surgical resection of clinically benign tumours in the maxillomandibular deep lobe of the parotid gland via sternocleidomastoid muscle–parotid space (SPS) approach. The use of maxillary–mandibular planes to subdivide the deep lobe of the parotid gland in order to establish the tumour location and accessibility is introduced. This approach, which does not raise a skin flap, may preserve the superficial lobe. Ten patients with clinically benign tumours in the maxillomandibular deep lobe of the parotid gland were treated via the SPS approach. The patients were followed up for 3–5 years and the surgical outcomes were analysed. All tumours were completely enucleated via the SPS approach with an optimal aesthetic outcome. No permanent facial weakness or tumour recurrence was identified during the 3–5 years of follow-up. The SPS approach to surgical resection is an ideal option for clinically benign tumours in the maxillomandibular deep lobe of the parotid gland and demonstrates good results.     

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目的 探讨采用肿瘤及其就位腺体区域性切除的方法治疗腮腺浅叶良性肿瘤的可行性。方法 对2004—2006年甘肃嘉峪关市第一人民医院口腔科收治的28例腮腺浅叶良性肿瘤患者,采用肿瘤及其就位腺体区域性切除+局部面神经解剖并且保留腮腺主导管的术式治疗,术后随访观察疗效。结果 28例腮腺浅叶良性肿瘤患者治疗后,经过3～5年的随访无一例复发,均达到治愈目的。术后并发症：出现面神经颧支暂时性瘫痪1例,颊支暂时性瘫痪2例,经应用营养神经药物治疗,1 ~ 3个月后均恢复正常;发生腮腺局部积液4例,经穿刺抽液换药,加压包扎后均得到痊愈,无一例涎瘘发生;出现味觉出汗综合征1例,但范围较小;愈后检查患者,手术侧凹陷不明显,面部左右基本对称,腮腺检查分泌功能基本正常。结论 肿瘤及其就位腺体区域性切除的方法是治疗腮腺浅叶多形性腺瘤或其他良性肿瘤合适的手术方式。与标准的保留面神经的肿瘤及腮腺浅叶或全腮腺切除术相比,能减少面神经损伤、涎瘘、味觉出汗综合征的发生,更重要的是能够保持面部形态的对称性,避免畸形等并发症的发生。     

内镜辅助下腮腺切除术14例报道

目的：探讨内镜辅助下进行腮腺手术切除的临床效果。方法：对2004年10月-2006年9月就诊的15例腮腺肿物住院患者采用无注气内镜辅助下腮腺切除手术。通过耳垂后下方皮纹小切口，在颈深筋膜浅层，采用高频超声刀切割分离，远端借助监视器锐性分离，暴露腮腺浅叶。内镜下解剖面神经主干及分支，超声刀切除腮腺，伤口负压引流。结果：耳垂后下方切口长4．0—5．4cm，平均4．8cm。手术麻醉时间平均115min。腮腺浅叶切除3例，部分腮腺浅叶切除11例。术后病理诊断为多形性腺瘤8例，Warthin瘤4例，淋巴上皮病1例，淋巴结反应性增生1例。随诊6～31个月，平均14个月。面神经轻度麻痹5例，均在6个月内恢复正常。结论：内镜辅助下腮腺切除手术适用于腮腺浅叶良性肿瘤的切除，切口小且隐蔽，手术创伤小，有利于患者的恢复。     

Ectopic bone formation as a complication of surgical rehabilitation in patients with Moebius' syndrome.

PURPOSE: Treatment of facial paralysis by muscular neurotization resulted in ectopic ossification in 1 of 134 cases in this department. That patient suffering from Moebius syndrome (MS) is presented. Reviewing the literature concerning MS, Hox genes and bone morphogenetic protein dysregulation, a pathogenesis of ossification in MS is suggested. PATIENT: The MS patient exhibited a congenital facial nerve palsy, which was treated by muscular neurotization (Lexer-Rosenthal). Because of postoperative ossification of scarred areas, osteotomy of the processus muscularis and mobilization of the masseter muscle was performed. Nevertheless, further ossification occurred at the interface between the mandible and zygoma and in two masticatory muscles. So, the construction of a neoarthrosis became necessary. Three years later, the iatrogenic bone defect had reossified despite of an active opening therapy. CONCLUSIONS: Ectopic ossification after muscular neurotization seems to be restricted to patients with MS and is triggered by trauma. Molecular pathogenesis: facial malformations in MS are caused by disturbances in embryonic patterning. Failure in the development of the second pharyngeal arch leads to a spatial BMP-4 dysregulation responsible for ossification after wounding of muscle fascia. Therefore, surgical rehabilitation of facial function by muscular neurotization is contra indicated in MS patients.     

改良美容切口联合胸锁乳突肌瓣在腮腺良性肿瘤切除术中的应用

目的:探究改良美容切口联合胸锁乳突肌瓣在腮腺肿瘤切除术中的应用.方法:选取2016年8月～2020年7月在我院接受腮腺良性肿瘤切除术治疗的104例腮腺良性肿瘤患者,按照随机分组法分为改良美容切口组与联合治疗组,各52例.改良美容切口组选择改良美容切口,联合治疗组选择改良美容切口并采用胸锁乳突肌瓣进行组织缺损区修复.记录...     

Extracapsular dissection of pleomorphic adenoma of the parotid gland through minimal preauricular and retroauricular incisions in children

We evaluate treatment outcomes in children with benign parotid neoplasms who underwent extracapsular dissection of the tumor using minimal incisions. Nine pediatric patients (4 boys and 5 girls) with pleomorphic adenoma of the parotid gland were treated with extracapsular dissection via preauricular and retroauricular incisions. The mean age of the patients at the time of surgery was 9.4 years. The size of the tumors ranged from 1.5 × 1.4 to 3.5 × 3.0 cm. Seven tumors were located in the superficial lobe of the parotid gland and 2 were located in the deep lobe. All histologically confirmed cases of malignancy were excluded. All 9 operations were performed successfully. No patient exhibited any permanent postoperative complication. Neither hematomas of the parotid region nor salivary fistula occurred. One patient had slight transient postoperative facial paresis. The scars were almost invisible. All patients had excellent cosmetics and complete function of the facial nerve. The patients were followed up for 5.1 to 7.0 years. Tumor recurrence developed in 1 patient who subsequently underwent curative parotidectomy. Extracapsular dissection through preauricular and retroauricular incisions is a feasible technique, providing excellent cosmetic outcome in the treatment of benign parotid neoplasms in children.     

经口内入路切除下颌骨良性肿瘤及同期血管化腓骨肌瓣精确重建下颌骨

目的： 首次介绍口内入路行下颌骨良性肿瘤切除和显微血管吻合的腓骨肌瓣即刻精确重建的经验。方法： 2018年1月—3月,对我科收治的4例下颌骨良性肿瘤患者行经口内入路的下颌骨节断性切除及显微血管吻合的腓骨肌瓣即刻重建术。3例术前行虚拟手术计划设计,并行钛板数字化压模成型。术中先在口内颊部显露面动、静脉并保护,按截骨导板完成下颌骨节断性切除和腓骨瓣塑形、钛板固定后,用导航验证重建下颌骨的位置。显微镜下将腓动脉与面动脉作端-端吻合,腓静脉与面静脉用微血管吻合器Coupler吻合。术后常规采用手提超声多普勒监测血管血流信号;术后1周复查全景片,检查重建下颌骨的位置。结果： 4例患者均顺利完成经口内入路的下颌骨节断性切除、腓骨重建,其中3例顺利完成口内显微血管吻合,1例因术区瘢痕、面静脉不理想而引至下颌下吻合。术后超声多普勒监测显示血流信号正常,口内及供区伤口均一期愈合。术中导航及术后全景片显示重建的下颌骨位置理想,咬合关系正常,面部外形对称,无面瘫及开口受限。结论： 经口内入路行下颌骨良性肿瘤的节断性切除及腓骨肌瓣精确重建和口内显微血管吻合是完全可行的,能够达到口外入路同样的效果,同时口外无瘢痕。     

头皮冠状切口不同位置切开骨膜对面神经的影响

目的:研究头皮冠状切口手术时,行表浅肌肉腱膜系统(superficial muscle aponeurotic system,SMAS)下分离,不同位置切开骨膜暴露骨折的位置,对面神经颞支、颧支损伤的影响。方法:对27例面中部骨折行头皮冠状切口患者分别采用,方法Ⅰ:沿SMAS下分离至眶上缘上2cm处和颧弓上1.5cm处,先在此切开骨膜和颞深筋膜浅层,分离暴露骨折;方法Ⅱ:沿SMAS下分离至眶上缘和颧弓处,然后再在眶上缘上2cm和颧弓上1.5cm切开直至暴露骨折;方法Ⅲ:同方法Ⅱ分离至眶上缘及颧弓处并直接切开骨膜,暴露骨折。术后7d、1个月、半年随访,对比三种方法的优劣。结果:方法Ⅱ和方法Ⅲ在术后出现不同程度面神经颞支、颧支受损症状,方法Ⅰ术后未出现面神经损伤症状。结论:头皮冠状切口行SMAS下分离至眶上缘上2cm处和颧弓上1.5cm处,切开暴露骨折,是一种临床安全可行的方法。