改良鼻唇沟皮瓣修复前颊部黏膜缺损

发布时间：2018-03-29 15:40

本文选题：改良鼻唇沟皮瓣　切入点：前颊部　出处：《中国修复重建外科杂志》2015年05期

【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。
[Abstract]:Objective to evaluate the efficacy of modified nasolabial flap in repairing small and medium-sized defects of anterior buccal mucosa. Methods from March 2013 to April 2014, 10 patients with anterior buccal mucosal lesions (8 males and 2 females), aged 3962 years with an average of 47.2 years, and 4 patients with left buccal mucosal lesions were treated. There were 6 cases of right side, 3 cases of oral leukoplakia, 3 cases of leukoplakia, 1 case of carcinogenesis of oral lichen planus and 3 cases of papilloma. The course of disease ranged from 2 to 15 months (mean 7.1 months). The defect was 2.5 ~ 4.0 cm wide, 3.55 ~ 5.5 cm long, and 0.5 ~ 1.5 cm from the angle of mouth. The designed pedicle was located next to the mouth angle. The long axis of the modified nasolabial flap along the nasolabial groove direction would be up from the superficial muscle aponeurosis system, and the lower wing would be lifted from the end to the pedicle. The flap was turned over through the buccal tunnel to repair the mucosal defect, and the incision of the external donor area was closed and sutured directly. Results the nasolabial flap survived and the wound healed in the first stage, and the incision of the extraoral donor area healed in the first stage. All the patients were followed up. The follow-up time was 6 ~ 18 months (mean 10.4 months). The patients had no recurrence, symmetrical and satisfactory facial shape, no stretch deformation of the lateral organs, no obvious hyperplasia of linear scar and hidden in the nasolabial sulcus of the operative side, and no symptom of nerve injury. The width of oral fissure was not significantly reduced compared with that before operation. At the last follow-up, the opening degree was 2.7 ~ 3.5 cm, with an average of 3.1 cm. The intraoral flap was thin and smooth, healed well with the surrounding mucosa, and had no obvious flap contracture. Conclusion the modified nasolabial flap has the advantages of reliable blood supply, flexible design, simple preparation and hidden donor area, and is one of the effective methods for repairing the small and medium-sized defects of the anterior cheek mucosa.
【作者单位】：中南大学湘雅医院口腔颌面外科;中南大学湘雅医院手术室;
【分类号】：R782.2

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