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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 curative effect of the modified nasolabial flap on small and medium mucosa defects in the anterior cheek. Methods From March 2013 to April 2014, 10 cases of anterior cheek mucosal lesions were treated. 8 males and 2 females; aged 39 to 62 years, an average of 47.2 years old. 4 cases on the left and 6 cases on the right. 3 cases of oral leukoplakia, 3 cases of malignant white spot, 1 case of oral lichen planus, 3 cases of papilloma. Course of 2 to 15 months, an average of 7.1 months. After the complete removal of lesions left mucosa and a small amount of buccal muscle defects, but not pierced the cheek. The defect is 2.5-4.0 cm wide, 3.5-5.5 cm long and 0.5-1.5 cm away from the mouth. Design pedicle at the mouth next to the long axis along the nasolabial direction of the nasolabial fold modified nasolabial flap from the superficial muscular aponeurosis system level, the lower wing from the end to the pedicle off the flap through the buccal Department of the tunnel flip to reach the mouth for the repair of mucosal defects, oral supply directly incision suture closure. Results The nasolabial flap was survived and the wound was healed in the first stage. The incision outside the mouth was healed by first intention. All patients were followed up for 6-18 months with an average of 10.4 months. No recurrence of lesions in patients with symmetry of facial symmetry, facial surgery without traction deformation, linear scar no significant proliferation and hidden in the lateral nasolabial fold surgery, no facial nerve injury symptoms, mouth shape normal. Cleavage width no significant reduction compared with preoperative, the last follow-up opening 2.7 to 3.5 cm, an average of 3.1 cm. Intraoral flap thin formation, with good healing around the mucosa, no obvious flap contracture, bite buccal and closed incomplete phenomenon. Conclusion The modified nasolabial flap is reliable in blood supply, flexible in design, simple in preparation and concealed in the donor area. It is one of the effective methods to repair small and medium mucosa defects in the anterior cheek.