前臂皮瓣联合钛网和颊脂垫修复口腔癌术后的上颌骨缺损

目的观察前臂皮瓣联合钛网和颊脂垫修复上颌骨缺损的临床效果。方法对3例上颌牙龈癌和1例腭部腺样囊性癌分别行上颌骨次全切除或全切除术,遗留的缺损用4 cm×5 cm~5 cm×7 cm大小的前臂皮瓣联合钛网和颊脂垫修复。其中钛网用于恢复上颌骨前外侧面、牙槽突和腭部形态,前臂皮瓣用于修复腭部口腔面黏膜缺损,颊脂垫用于修复腭部鼻腔面黏膜缺损。术后通过临床检查及CT和鼻内窥镜检查评价其效果。结果随访1~3年,肿瘤无复发,移植皮瓣全部成活,面部外形及牙槽突和腭部形态恢复良好,鼻腔面钛网被软组织覆盖,佩戴可摘局部义齿修复缺牙后,语言和进食功能恢复良好。结论前臂皮瓣联合钛网和颊脂垫修复上颌骨缺损效果理想。

Repairing of maxillary defects caused by resection of oral carcinoma with forearm flap with titanium mesh and buccal fat pad

Objective To investigate the clinical effects of forearm flap with titanium mesh and buccal fat pad in repairing of maxillary defects.Methods Maxillary defects were reconstructed with free forearm flap ranging from 4 cm×5 cm to 5 cm×7 cm with titanium mesh and buccal fat pad following subtotal maxillectomy or total maxillectomy due to oral carcinoma in four patients.Titanium mesh was used to reconstruct the anterolateral surface of maxillary bone,alveolar process and palate.Forearm flap was used to reconstruct oral mucosa defect of palate.Buccal fat pad was used to reconstruct nasal mucosa defect of palate.The effects were studied by clinical examination,CT and nasopharyn-goscope.Results Four cases were followed up for 1-3 years.All the flaps were alive.Facial,alveolar process and palatal contour were restored well.Epithelium was found on the nostril surface of the titanium mesh.Speech and chew functions were restored well after removable partial dentures were worn.Conclusion The free forearm flap with titanium mesh and buccal fat pad are believed to be the more ideal methods for reconstruction of maxillary defects.