应用颊肌粘膜瓣转移延长软腭  

Clinical application of the buccinator musculomucosal flap to lengthen the soft palate

作　　者：赵穆欣[1] 李养群[1] 李森恺[1] 唐勇[1] 杨哲[1] 李锋永[1] 

机构地区：[1]中国医学科学院北京协和医学院附属整形外科医院整形二科,北京100144

出　　处：《中国美容医学》2009年第4期476-478,共3页Chinese Journal of Aesthetic Medicine

摘　　要：目的:探讨颊肌粘膜瓣的解剖及应用其延长软腭,同时改善腭咽闭合不全。方法:在软硬腭交界处切开腭粘膜肌层,腭肌下分离,形成以舌腭弓为蒂的口腔侧腭粘膜肌瓣。由软腭正中纵形切开鼻腔侧粘膜,形成边长为1.0～1.5cm的对偶三角瓣,交叉缝合。口腔侧腭粘膜肌瓣后推位与鼻腔侧粘膜瓣缝合固定,软硬腭交界处形成一个横形创面,应用一侧颊肌粘膜瓣转移覆盖以延长软腭,供瓣区直接缝合。结果:本组16例患者,软腭平均延长1.0～1.5cm,腭咽闭合不全基本矫正。颊肌粘膜瓣无一例出现血运障碍。结论:应用鼻腔粘膜的"Z"字成形及口腔侧的腭粘膜肌瓣后推,颊肌粘膜瓣转移,能有效地延长短缩的软腭,明显改善腭咽闭合不全,使腭裂音质的改善有了解剖学基础。Objective To discuss the anatomy and clinical application of the buccinator musculomucosal flap. We use it to lengthen the soft palate and correct velopharyngeal incompetence. Methods The junction of the hard and soft palate was marked and divided, detaching the soft palate beneath the palatine muscle and creating a oromuscular flap which is pedicled by palatoglossus arch. Then we made a longitudinal incision on the nasal mucosa to perform the double-opposing Z plasty whose arm was 1.0-1.5cm long. The oromuscular flap was pushed back and sutured to the nasal mucosal flap. The defect on the junction would be reconstructed using the unilateral buccinator flap. And the donor site is closed directly. Results All the 12 patients had a significant improvement in velopharyngeal incompetence. The average increased length of soft palate was 1.0 -1.5cm. There is no flap necrosis occurred. Conclusions The technique of nasal mucosa Z plasty, pushback of oromuscular flap and transferring of the buccinator musculomucosal flap for the correction of velopharyngeal incompetence was successful in increasing palatal length, achieving good speech results and supplying a more sound anatomical basis.

关 键 词：颊肌粘膜瓣 腭咽闭合不全 延长软腭 

分 类 号：R782.2[医药卫生—口腔医学]