改良鼻唇沟皮瓣修复前颊部黏膜缺损  

EXTENDED NASOLABIAL FLAPS IN MANAGEMENT OF ANTERIOR BUCCAL MUCOSAL DEFECTS

作　　者：陈洁[1] 蒋灿华[1] 陈立纯[2] 李宁[1] 任辉[1] 吴立萌 翦新春[1] 

机构地区：[1]中南大学湘雅医院口腔颌面外科,长沙410008 [2]中南大学湘雅医院手术室,长沙410008

出　　处：《中国修复重建外科杂志》2015年第5期582-585,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨改良鼻唇沟皮瓣修复前颊部黏膜中小型缺损的疗效。方法 2013年3月-2014年4月,收治10例前颊部黏膜病变患者。男8例,女2例;年龄39~62岁,平均47.2岁。左侧4例,右侧6例。口腔白斑3例,白斑恶变3例,口腔扁平苔藓癌变1例,乳头状瘤3例。病程2~15个月,平均7.1个月。病变彻底切除后遗留黏膜和少量颊肌缺损,但未洞穿颊部。缺损宽2.5~4.0 cm、长3.5~5.5 cm,距离口角0.5~1.5 cm。设计蒂部位于口角旁、长轴沿鼻唇沟方向的弯月形改良鼻唇沟皮瓣,自表浅肌肉腱膜系统层面将上、下翼由末端向蒂部掀起,将皮瓣经颊部隧道翻转到达口内用于修复黏膜缺损,口外供区切口直接拉拢缝合。结果术后鼻唇沟皮瓣均成活,创面Ⅰ期愈合;口外供区切口Ⅰ期愈合。患者均获随访,随访时间6~18个月,平均10.4个月。患者病变无复发,面型对称满意,术侧面部器官无牵拉变形,线性瘢痕无明显增生且隐藏于术侧鼻唇沟内,未见面神经损伤症状,口角形态正常。口裂宽度较术前无明显缩小,末次随访时开口度2.7~3.5 cm,平均3.1 cm。口内皮瓣菲薄平整,与周围黏膜愈合良好,无明显皮瓣挛缩、咬颊和闭口不全等现象发生。结论改良鼻唇沟皮瓣具有血供可靠、设计灵活、制备简单、供区隐蔽等优点,是修复前颊部黏膜中小型缺损的有效方法之一。Objective To investigate the feasibility of the extended nasolabial flap in repairing small or medium anterior buccal mucosal defects.Methods Between March 2013 and April 2014,10 patients with anterior buccal mucosal defects were treated with extended nasolabial flaps.There were 8 males and 2 females with the average age of 47.2 years（range,39-62 years）.The left side was involved in 4 cases and the right side in 6 cases.The pathological types included 3 cases of oral leukoplakia（OLK）,3 cases of OLK with malignant changes,1 case of malignant oral lichen planus,and 3 cases of papilloma.The clinical course ranged from 2 to 15 months（mean,7.1 months）.The resection was restricted to the mucosa and little buccinators without cheek penetration,and the defects ranged from 2.5 to 4.0 cm in width and 3.5 to 5.5 cm in length.The distance between defect and the corner of the mouth was 0.5 to 1.5 cm.A falcate flap was designed along the nasolabial fold with a pedicle lateral beside the corner of the mouth.The flap was lifted in the plane of the superficial muscular aponeurotic system from both terminal points to the region of the central pedicle.Then the flap was transposed intraorally through a transbuccal tunnel to cover the mucosal defect while the extra-oral incision was closed directly.Results All flaps completely survived and all wounds healed primarily.All patients were followed up 6 to 18 months（mean,10.4 months）.All patients regained symmetrical appearances and normal mouth commissure only with linear scars hidden in the nasolabial folds.The mouth opening was 2.7 to 3.5 cm（mean,3.1 cm） at last follow-up.The intraoral flaps healed perfectly with thin and flat outlooks.No cheek biting or fish-mouth deformity was observed.Conclusion The extended nasolabial flap can be used to repair small or medium anterior buccal mucosal defects because it has the advantages of reliable blood supply,flexibility in design,simplicity in harvesting,and hidden donor site scars.

关 键 词：改良鼻唇沟皮瓣 前颊部 黏膜缺损 创面修复 

分 类 号：R782.2[医药卫生—口腔医学]