颊脂垫瓣在口腔缺损修复中的应用

目的评价颊脂垫瓣在修复口腔黏膜缺损中的应用。方法1998年5月~2004年7月,收治42例各种原因致口腔缺损患者,其中男26例,女16例,年龄25~76岁。颊部鳞癌7例,颊部白斑5例,软腭部鳞癌7例,腭部腺样囊性癌8例,上颌窦癌6例,上颌齿槽突血管瘤5例,上颌骨角化囊肿4例。病程2个月~10年。缺损部位颊部12例,上颌骨切除导致颊部上分缺损6例,口腔上颌窦瘘17例,软腭部缺损7例。缺损范围3.0cm×3.0cm~6.5cm×4.0cm。均采用颊脂垫瓣修复缺损部位,切取的颊脂垫瓣为颊脂垫的颊突及部分体部。结果术后41例颊脂垫瓣与创面期愈合;1例因缺损大,瓣成形后较薄而期愈合。术后4周水肿消退逐渐上皮化,6周完全上皮化,颊部外观无明显影响。35例获随访3个月~5年,颊脂垫瓣修复区与附近正常黏膜的层次和颜色、弹性、光滑度、质地无明显差异,咀嚼摩擦和食物刺激无明显影响。2例磨牙后区缺损者有轻度张口受限,经过开口训练恢复张口度。结论颊脂垫瓣能较快而有效地修复直径6.5cm以下的黏膜缺损,取材方便,术后无明显的供区并发症,是修复颊部、软腭和牙槽等部位黏膜缺损的理想组织。其缺点为修复范围较局限。

RECONSTRUCTION OF ORAL MUCO-DEFECTS WITH BUCCAL FAT PAD FLAP

OBJECTIVE: To evaluate the clinical outcome of the buccal fat pad flap in reconstruction of defects of the oral mucosa. METHODS: From May 1998 to July 2004, 42 patients with oral muco-defects were treated with buccal fat pad flap. Of them, there were 26 males and 16 females, aging 25-76 years. The defect was caused by buccal squamous carcinoma in 7 cases, by buccal leukoplakia in 5 cases, by squamous carcinoma of soft palate in 7 cases, by adenoid cystic carcinoma of palate in 8 cases, by carcinoma of maxillary sinus in 6 cases, by maxillo-alveolar angioma in 5 cases and by keratocyst of maxilla in 4 cases. The locations were buccal mucosa, maxillary sinus and soft palate. The size of defect ranged from 3.0 cm x 3.0 cm to 6.5 cm x 4.0 cm. RESULTS: Forty-one cases achieved healing by first intention, except one case because of large defect. Edema faded and epithelization occurred after 4 weeks of operation. Complete epithelization was observed after 6 weeks of operation. Thirty-five cases were followed up 3 months to 5 years. There were no obvious differences in layers, color, elasticity, and texture between repaired region and adjacent mucosa. CONCLUSION: The buccal fat pad flap is useful in reconstructing the muco-defects (less than 6.5 cm in diameter) of the posterior maxilla and buccal region without considerable complication. The multiplex blood supply, facility in accessing and minimal donor site morbidity make it a reliable soft tissue graft. The main shortcoming is its limited size.