作者：Lin, Chih-Hung M.D.; Wallace, Christopher M.D.; Liao, Chun-Ta M.D.
文章發表：Plastic and Reconstructive Surgery: September 2011 - Volume 128 - Issue 3 -
大綱
一、背景：合併臉部肌肉組織/神經的腫瘤切除後口面部缺損會引起半臉表達功能障礙，但使用自由功能的肌皮瓣很少被報導。二、方法：24位口腔腫瘤患者進行了功能性肌皮瓣移植及顏面神經纖維接合重建。另外這些患者接受了15個游離皮瓣來修復廣泛的複合缺陷。在2年後無復發的追蹤，根據Terzis標准評分微笑結果，比較術後放療，口腔結合完整性和雙游離皮瓣的效果。三、結果：18例患者完成了2年的無復發追蹤；平均笑容為Terzis 4級（平均3.8）。蝸軸的切除/重建（18例中的5例）傾向於降低預後（Terzis 3級，平均值3.0；中位數3；平均水平3）。對Terzis 4級平均值為4.1；中位數為5）與同時進行的兩個游離皮瓣比較（平均值為3.56對4.14；平均值為3對5）。術後放療（18例患者中的8例）對預後的影響較小（Terzis 3級，平均3.3；Terzis 4級，平均4.1；中位數：3比5）。四、結論：包括表達性臉部肌肉組織/神經在內的功能性肌肉轉移的腫瘤缺陷重建要可以恢復可靠的口腔的自控力和臉部表情。
BACKGROUND:
Ablative orofacial defects incorporating mimetic facial musculature/nerve cause hemifacial expressive dysfunction and considerable morbidity but are rarely reanimated immediately using free functioning gracilis myocutaneous flaps.
METHODS:
Disrupted buccal branches provided a recipient facial nerve for 24 gracilis reinnervations. An additional 15 free flaps were used for extensive composite defects. Smile outcome was graded according to Terzis' criteria after 2 years of recurrence-free follow-up. The effects of postoperative radiotherapy, integrity of the oral commissure, and double free flaps were compared.
RESULTS:
Eighteen patients completed 2 years' recurrence-free follow-up; average smile outcome was Terzis grade 4 (mean, 3.8). Resection/reconstruction of the modiolus (five of 18 patients) tended to diminish outcome (Terzis grade 3, mean, 3.0; median, 3; versus Terzis grade 4, mean, 4.1; median, 5) compared with two free flaps performed simultaneouly (mean, 3.56 versus 4.14; median, 3 versus 5). Postoperative radiotherapy (eight of 18 patients) had a more modest effect on outcome (Terzis grade 3, mean, 3.3; Terzis grade 4, mean, 4.1; median, 3 versus 5).
CONCLUSIONS:
Reconstruction of oncologic defects including expressive facial musculature/nerve with gracilis free functioning muscle transfer can restore oral continence and facial expression primarily.
Comments