冠突颞肌瓣联合血管化腓骨肌皮瓣修复全上颌骨缺损  

Application of vascularized fibular flap combined with coronoid temporalis pedicle flap in the reconstruction of maxillary Class IIIb defect

作　　者：于淼[1] 秦兴军[1] 刘剑楠[1] 张陈平[1] 徐立群[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科,上海市口腔医学重点实验室,上海200011

出　　处：《中国口腔颌面外科杂志》2014年第5期462-466,共5页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的:探讨冠突颞肌瓣联合血管化腓骨肌皮瓣修复全上颌骨缺损的手术方式及临床价值。方法 :收集2例上颌骨全切术后面中部缺损畸形(James BrownⅢb类)患者,采用冠突颞肌瓣联合血管化腓骨肌皮瓣行全上颌骨重建,术前应用Surgicase 5.0(Materialise,Belgium)软件进行手术规划,对手术方式及术后效果进行预测分析。术中以冠突颞肌瓣旋转修复眶底,冠突大小分别为3.5 cm×1.5 cm及4.0 cm×1.6 cm;以2段式腓骨塑形修复牙槽突,腓骨长度分别为32.51 mm、27.36 mm及71.82 mm、38.74 mm;以腓骨肌皮瓣携带皮岛修复面中部软组织缺损。结果:术中检查冠突颞肌瓣血供良好,术后腓骨肌皮瓣均成活,创口一期愈合。分别随访5个月和6 a,无复视、睑外翻及眼球突出,无涎瘘、下唇麻木等并发症,开口度正常。CT检查眶底及牙槽突重建形态良好。结论:冠突颞肌瓣联合血管化腓骨肌皮瓣发挥了不同组织瓣的优势,是全上颌骨缺损重建的良好选择。PURPOSE： To explore the method and value of vascularized fibular flap combined with coronoid temporalis pedicle flap in reconstruction of maxillary Class IIIb defect. METHODS： Two patients who underwent maxillary reconstruction using vascularized fibular flap combined with coronoid temporalis pedicle flap following maxillectomy in secondary stage were reviewed. The methods and effects were predicted using Surgicase 5.0（Materialise, Belgium）. The orbital floors were reconstructed with the coronoid temporalis pedicle flap measuring 3.5 cm ×1.5 cm and 4.0 cm×1.6 cm;the alveolar processes were reconstructed with fibula flap dividing into 2 segments measuring 32.51 mm, 27.36 mm and71.82 mm, 38.74 mm, respectively. Skin and mucosa defects were reconstructed with skin paddle of fibula flap.RESULTS： The coronoid temporalis pedicle flaps had good blood supply. The fibula flaps survived, and all of the wounds healed uneventfully. The follow-up time was 5 months and 6 years, respectively, during which no diplopia, ectropion and exophthalmos occurred, no salivary fistula or numbness of lower lip appeared. CT scan showed a good profile of orbital floor and alveolar process. CONCLUSION： Vascularized fibular flap combined with coronoid temporalis pedicle flap takes full advantages of different kinds of flaps and is a good choice to reconstruct midfacial defects after total maxillectomy.

关 键 词：全上颌骨缺损 冠突颞肌瓣 腓骨肌皮瓣 

分 类 号：R782.2[医药卫生—口腔医学]