Iyer Subramania, Chatni Shilpa, Kuriakose Moni A
Department of Plastic and Reconstructive Surgery and Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Ann Plast Surg. 2012 Jan;68(1):52-7. doi: 10.1097/SAP.0b013e31820ebc19.
Reconstruction of maxillectomy with extensive orbital rim and floor excision defects is a challenging problem. The goal of reconstruction here is to provide adequate orbital support to prevent enophthalmos and diplopia as well as obturation of the palatal defect. The existing methods of the reconstruction fail to simultaneously address these 2 goals of reconstruction. A new method of reconstruction of these defects using tensor fascia lata-iliac crest flap was used in 7 cases of cancers of the maxilla, which necessitated extensive resection of the orbital floor along with the maxillectomy. The flap was raised as a muscle and bone flap in 5 cases and in 2, a skin paddle was included. The immediate and delayed outcome at 6-month follow-up was analyzed. The functional outcome with regards to the ocular position and function, palatal obturation, speech, and swallowing were recorded. The bone viability at 6 months was assessed by computed tomography scan. The flap was successful in all the 7 cases. The delayed outcome assessment showed that the orbital support was excellent with no diplopia in all the cases. The palatal defect could be covered successfully in all the cases, resulting in normal speech and swallowing. The computed tomography scan showed excellent integration of the bone. The free tensor fascia lata-iliac crest flap is a reliable and safe method of reconstruction of the orbitomaxillary defects, addressing the issues of both orbital support and palatal obturation.
广泛眶缘和眶底切除术后上颌骨切除术的重建是一个具有挑战性的问题。此处重建的目标是提供足够的眼眶支撑，以防止眼球内陷和复视，以及封闭腭部缺损。现有的重建方法无法同时实现这两个重建目标。一种使用阔筋膜张肌-髂嵴瓣重建这些缺损的新方法应用于7例上颌骨癌患者，这些患者在行上颌骨切除术时需要广泛切除眶底。5例患者将皮瓣作为肌肉和骨瓣掀起，2例患者包含皮瓣。分析了6个月随访时的即刻和延迟结果。记录了关于眼球位置和功能、腭部封闭、言语和吞咽的功能结果。通过计算机断层扫描评估6个月时的骨活力。7例患者的皮瓣均成功。延迟结果评估显示，所有病例的眼眶支撑良好，无复视。所有病例的腭部缺损均能成功覆盖，从而实现正常的言语和吞咽功能。计算机断层扫描显示骨整合良好。游离阔筋膜张肌-髂嵴瓣是一种可靠且安全的眶上颌缺损重建方法，可解决眼眶支撑和腭部封闭这两个问题。
