Peleg Michael, Sawatari Yoh, Lopez Eustorgio A
Division of Oral and Maxillofacial Surgery, Miller School of Medicine, University of Miami, Miami, Florida 33176, USA.
J Craniofac Surg. 2011 Jan;22(1):365-70. doi: 10.1097/SCS.0b013e3181f81634.
The pectoralis major myocutaneous flap (PMMF) is commonly used for oral cavity reconstruction, yet its impact on function (intelligible speech, swallowing, mastication, tongue mobility, oral competence, and mouth opening) has rarely been studied or reported in the literature.
This study assessed the long-term functional outcome of oral cavity reconstruction with PMMF, placing particular emphasis in its correlation with size of the skin paddle and volume of the flap.
Twenty-five patients who underwent reconstruction of compound defects of the oral cavity that involved floor of mouth, buccal mucosa, alveolar ridge, retromolar area, lateral tongue, and continuity of mandible were assessed and followed up for up to 4 years. Assessment of function was based on predetermined clinical parameters along with consecutive measurements of skin paddle size.
At 6 months, the size of the skin paddles averaged a 37% decrease in size, along with a marked reduction in the mass effect from the flap. Tongue mobility was considered good in all patients. Speech was considered intelligible in 84% of patients, of which 16% required some concentration to understand. Initial complaints of difficulty swallowing resolved in every patient and mouth opening in all patients returned to their preoperative state. These findings were maintained consistently throughout the follow-up period. Flap complications, consisting of partial skin paddle necrosis, occurred in 4 patients (16%), but healed after local debridement. Intraoral hair in the skin paddle was present in 5 men who did not receive postoperative radiotherapy.
Reconstruction of the oral cavity (including defects with partial involvement of the tongue and continuity of mandible) can be predictably accomplished using PMMF. These procedures are associated mostly with minor and temporary disruption of function and quality of life and few complications.
胸大肌肌皮瓣（PMMF）常用于口腔重建，但关于其对功能（可理解的言语、吞咽、咀嚼、舌活动度、口腔功能及开口度）的影响，在文献中很少有研究或报道。
本研究评估了采用PMMF进行口腔重建的长期功能结果，特别强调其与皮瓣大小及皮瓣体积的相关性。
对25例接受口腔复合缺损重建的患者进行评估并随访长达4年，这些缺损累及口底、颊黏膜、牙槽嵴、磨牙后区、舌侧及下颌骨连续性。功能评估基于预先确定的临床参数以及对皮瓣大小的连续测量。
6个月时，皮瓣大小平均缩小37%，皮瓣的质量效应也显著降低。所有患者的舌活动度均良好。84%的患者言语可理解，其中16%的患者需要集中精力才能理解。每位患者最初吞咽困难的主诉均得到缓解，所有患者的开口度均恢复到术前状态。在整个随访期间，这些结果一直保持稳定。4例患者（16%）出现皮瓣并发症，包括部分皮瓣坏死，但经局部清创后愈合。5例未接受术后放疗的男性患者皮瓣内出现口腔内毛发。
使用PMMF可预期完成口腔重建（包括舌部分受累及下颌骨连续性缺损）。这些手术大多仅伴有轻微和暂时的功能及生活质量干扰，且并发症较少。
