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目的:探讨用逆行蒂颏下岛状组织瓣修补头面部缺损。方法:回顾性分析我院耳鼻咽喉头颈外科2004年1月至2006年12月间行逆行蒂颏下组织瓣修补因肿瘤切除导致面部、上颌或咽部缺损10例,男6例,女4例,年龄24～76岁,中位年龄55岁。其中上睑皮肤黑色素瘤手术缺损1例,硬腭肌上皮瘤2例,上颌造釉细胞瘤1例;扁桃体癌4例,舌根癌2例。根据手术缺损大小切取颏下组织瓣,以面动静脉远心端为蒂,经面部皮下或经颌下转移至缺损区修补缺损。4例扁桃体癌和2例舌根癌同期行同侧经典颈清扫术。方法:术后皮瓣均有不同程度肿胀苍白或淤血,5d后皮瓣肿胀逐渐消退,色泽逐渐恢复正常。1例淤血严重,经针刺放血,药物治疗,一期愈合。另一例皮瓣与硬腭在中缝处裂开2cm,再次清创缝合后愈合,1例同侧口角轻度偏斜,药物治疗3个月后恢复。所有病例术后皮瓣均成活。结论:逆行蒂颏下组织瓣由于蒂在上方,可以向上转移较远距离而修补面中部、眼裂周围缺损,并且可同时行颈淋巴结清扫手术,也是修补有颈淋巴结转移的口咽部恶性肿瘤手术缺损的一种良好选择。
Objective: To investigate the repair of facial and facial defect with retrograde pedicle submucosal island flap. Methods: Retrospective analysis of 10 cases of facial, maxillary or pharyngeal defect due to tumor resection retrospectively performed between January 2004 and December 2006 in our department of Otolaryngology Head and Neck Surgery from January 2004 to December 2006. There were 6 males and 4 females , Aged 24 to 76 years old, the median age of 55 years old. Among them, there was 1 case of blepharocephalic melanoma surgery, 2 cases of hard palate myoepithelioma, 1 case of maxillary ameloblastoma, 4 cases of tonsil carcinoma and 2 cases of tongue root cancer. According to the size of the surgical defect, the submental tissue flap was excised and repaired with subcutaneous or submandibular transfer to the defect area by the facial veins. Four cases of tonsil carcinoma and two cases of tongue carcinoma were treated with ipsilateral classic neck dissection. Methods: The flaps had varying degrees of swelling or congestion after operation. The swelling of the flaps subsided gradually after 5 days and the color gradually returned to normal. One case of severe congestion, acupuncture bleeding, drug treatment, a healing. In another case, the flap and the hard palate were split 2 cm at the suture and healed again after debridement and suturing. One case was slightly skewed in the ipsilateral mouth and recovered after 3 months of drug treatment. All cases flap survived. Conclusion: The retrograde pedicle of the submental tissue pedicle is superior to the pedicle in the upper part of the pedicle. It can be moved upwards for a long time to repair the middle part of the face and defect around the ocular cleft, and can be performed simultaneously with cervical lymph node dissection. It is also an oropharyngeal malignancy to repair cervical lymph node metastasis A good choice for surgical defect.