摘要
口腔颌面区域内软组织常因各种原因造成大面积的缺损。组织缺损给患者带来了极大的痛苦,严重影响着患者的生存质量及社会适应能力,患者常迫切需求修复组织缺损及恢复形态功能。因此,口腔颌面部软组织器官的修复重建工作一直是修复重建外科领域的研究重点。同时由于其部位特殊、形态不一、功能复杂,因此,也是修复重建外科领域研究的难题。以往的组织瓣应用已在软组织修复工作中取得来了显著成绩,随着外科尤其是显微外科技术的成熟与应用,血管化组织瓣的应用使得软组织缺损的修复更加丰富,效果更加理想。面对众多可选的组织瓣修复方法,如何根据实际情况进行优选,是临床医生手术前必须认真思考的问题。总结各种修复方法不难发现,修复计划的设计均为经验性的,缺乏客观的各组织器官缺损形态的空间依据及应用不同组织瓣修复缺损后的疗效评价。因此,修复后常不能达到满意效果,多数情况仅是关闭创面,而不能达到恢复器官形态和功能的作用。
本研究针对口腔颌面部软组织器官缺损修复工作中,合理评价组织缺损量及优化设计组织瓣供量的基础与临床研究问题。选取华西口腔医院颌面外科需鼻插管全麻手术治疗的腮腺多形性腺瘤患者40例,男、女各20例,年龄20～65岁,平均42.5岁。进
Extensive soft tissue defect of oral and maxillofacial is an often and devastating event affecting patient life quality and adapt to society. It is necessary to restore oral and maxillofacial structure and function. So it is an important task for reconstruction surgery, reconstruction on oral and maxillofacial area is difficult because the facial structure is special and complicated founction. The technique had become cost efficient by using hemogeneous tissue flaps, and the technique had become the most efficient by using vascularized flap. What method should be adopted still present a considerable challenge to the surgeon. It can be found that the reconstruction method which surgeon chosen depends on their experience. There are no objective evaluation index for soft tissue struction and no efficient postoperative evaluation. So there are poor satisfaction with patients and surgeon.The aim of this study was to evaluate the defect quality of the oral and maxillofacial soft tissue (lip, cheek, tongue, floor of mouth, soft plate) of normal adults. The oral and maxillofacial soft tissue of 40 consecutive patients (20 man, 20 women) presenting with
pleomorphic adenoma who had received general anaesthesia in west china college of stomatollogy were measured,the average age of 42.5 years (min. 20,max. 65).To provide data for morphologic,and to provide reference for reconstruction of the oral and maxillofacial soft tissue defects. 402 patients (282 man, 120 woman) who had reconstruction of soft tissue in west china college of stomatollogy during 1995.08-2004.10 were followed up, the average age of 51.5 years (min. 28, max. 75) .The different defects were classificated by different area and range. Clinical effects of reconstruction patient were evaluated. It can be found that Local flap is preferred flap for reconstruction of lip and cheek defects; tongue flap, nasolabial flap, palatal flap is preferred for middle cheek mucosa defects, free radial forearm flap is preferred for large anterior cheek mucosa defects, pectoral major myocutancous flap is preferred for large lateral cheek mucosa deep defects ; free radial forearm flap - pectoral major myocutancous flap, folded double-paddle pectoral major myocutancous flap is fit for cheek full defects; nasolabial flap, free radial forearm flap, plasysma flap was fit for middle defects of tongue or floor of mouth, pectoral major myocutancous flap was fit for large defects of tongue or floor of mouth; tongue flap, platal flap was fit for part defect of soft plate, free radial forearm flap-palatal flap was fit for full defect of soft plate.Based on these findings, morphologic data of adult oral and maxillofacial soft tissue is reference for reconstruction surgery. The selection of reconstruction method should depend on the rage of defect,
site of defect and characteristic of flap. Generally, Local flap is preferred flap for reconstruction of lip and cheek defects; tongue flap, nasolabial flap, palatal flap is preferred for middle cheek mucosa defects, large defect was often filled with distant flap, free radial forearm flap is preferred for large anterior cheek mucosa defects, pectoral major myocutancous flap is preferred for large lateral cheek mucosa deep defects ; defect of tongue or floor of mouth was often reconstructed with distant flap , nasolabial flap, free radial forearm flap, plasysma flap was fit for middle defects of tongue or floor of mouth, pectoral major myocutancous flap was fit for large defects of tongue or floor of mouth; tongue flap, platal flap was fit for part defect of soft plate, free radial forearm flap-palatal flap was fit for full defect of soft plate.
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