Huang Yu-Hao, Lai Chung-Sheng, Lin Sin-Daw, Lee Su-Shin
Department of Surgery, Kaohsiung Medical University Hospital, Taiwan.
Ann Plast Surg. 2011 Dec;67(6):597-9. doi: 10.1097/SAP.0b013e3182085080.
Oronasal fistulas after oromaxillary surgery may sometimes be encountered and remain a challenging problem. They can cause significant disabilities such as phonetic problems and food or liquid regurgitation while swallowing. A few methods are reported to solve this problem, including using a dental appliance, local tissue rotation, or even free-tissue transfer.
An angular artery cutaneous flap was designed to repair the defect. The flap that included the skin and superficial fascia fed by the flow of angular artery was rotated through the buccal mucosa into the oral cavity to cover the palate defect.
Two oronasal fistula cases were reported in this series. Case 1: A 71-year-old man had hard palate cancer and had received wide excision in our hospital 2 years previously. He had received adjuvant radiotherapy (28 times) and was transferred to the plastic surgery department for dealing with oronasal fistula. The palate defect was 2 × 2 cm. Case 2: A 72-year-old woman was a patient with left palate mucoepidermoid carcinoma. She had received an operation and adjuvant radiotherapy 10 years previously. For her oronasal fistula and hypernasality, she had received reconstructive operations 3 times with local rotation flap for left-side palate defect at a previous hospital. However, the local flap failed and the fistula persisted. She then approached our plastic surgery department for help. The palate defect was about 1 × 1 cm. We successfully reconstructed the oronasal fistula by using the angular artery cutaneous flap. The flap successfully sealed the oral cavity during the follow-up period.
Angular artery cutaneous flap is a good alternative for reconstruction of the oronasal fistula. Especially in elderly patients, donor-site comorbidities are fewer due to the redundant aging skin and the missing tooth.
口腔颌面外科手术后有时会出现口鼻瘘，这仍然是一个具有挑战性的问题。它们会导致严重的功能障碍，如语音问题以及吞咽时食物或液体反流。据报道有几种方法可解决此问题，包括使用牙修复体、局部组织旋转，甚至游离组织移植。
设计了一种角动脉皮瓣来修复缺损。该皮瓣包含由角动脉供血的皮肤和浅筋膜，通过颊黏膜旋转进入口腔以覆盖腭部缺损。
本系列报告了2例口鼻瘘病例。病例1：一名71岁男性患有硬腭癌，2年前在我院接受了广泛切除。他接受了辅助放疗（28次），后转至整形外科处理口鼻瘘。腭部缺损为2×2厘米。病例2：一名72岁女性为左腭黏液表皮样癌患者。她10年前接受了手术及辅助放疗。因口鼻瘘和鼻音过重，她曾在之前的医院接受过3次左侧腭部缺损局部旋转皮瓣修复手术。然而，局部皮瓣失败，瘘口持续存在。随后她到我院整形外科寻求帮助。腭部缺损约为1×1厘米。我们成功地使用角动脉皮瓣重建了口鼻瘘。在随访期间，皮瓣成功封闭了口腔。
角动脉皮瓣是重建口鼻瘘的良好选择。特别是对于老年患者，由于老化皮肤多余且牙齿缺失，供区并发症较少。
