Lee H B, Hong J P, Kim K T, Chung Y K, Tark K C, Bong J P
Department of Plastic and Reconstructive Surgery, Yonsei University, Wonju College of Medicine, Korea.
Plast Reconstr Surg. 1999 Sep;104(3):646-53. doi: 10.1097/00006534-199909030-00005.
A number of techniques have been introduced to support the orbital floor after maxillectomy without orbital exenteration. These methods include skin graft or muscular sling, but they have resulted in severe complications, such as enophthalmos, global ptosis, diplopia, and facial deformity. Currently, advanced microvascular reconstruction using bone and soft tissue is performed by many surgeons. This usually results in the filling of the postmaxillectomy defect, but the lack of support for the orbital rim and floor by the bone flap may still cause the complications mentioned above. Vascularized calvarial bone flap was chosen in this study for reconstruction of the orbital floor and infraorbital rim to function as a buttress, to reconstruct recipient sites of poor vascular bed after radiation therapy, and to withstand further postoperative radiation. By providing a solid floor and rim, these complications can be prevented with satisfactory function and aesthetically acceptable results. From September of 1995 to July of 1998, we performed vascularized bone flap for the reconstruction of the orbital floor and infraorbital rim in four cases after total maxillectomy involving the orbital floor. With a follow-up period from 19 to 35 months (mean, 27 months), we obtained significant improvement of functional and aesthetically acceptable results without global ptosis, enophthalmos, diplopia, or severe facial contour deformity.
已经引入了多种技术来在不进行眶内容物剜除术的上颌骨切除术后支撑眶底。这些方法包括植皮或肌吊带，但它们导致了严重的并发症，如眼球内陷、上睑全下垂、复视和面部畸形。目前，许多外科医生采用先进的使用骨和软组织的微血管重建术。这通常能填充上颌骨切除术后的缺损，但骨瓣对眶缘和眶底缺乏支撑仍可能导致上述并发症。本研究选择带血管蒂的颅骨骨瓣来重建眶底和眶下缘，以起到支撑作用，重建放疗后血运差的受区，并耐受术后进一步放疗。通过提供一个坚实的眶底和眶缘，可以预防这些并发症，获得功能满意且美学效果可接受的结果。1995年9月至1998年7月，我们对4例累及眶底的全上颌骨切除术后患者采用带血管蒂骨瓣重建眶底和眶下缘。随访19至35个月（平均27个月），我们获得了功能显著改善且美学效果可接受的结果，没有出现上睑全下垂、眼球内陷、复视或严重面部轮廓畸形。
