Fort Sam Houston, Texas; Boston, Mass.; and Virginia Beach, Va. From the Division of Plastic Surgery, Brigham and Women's Hospital, and the Clinical Division and Burn Center, Brooke Army Medical Center.
Plast Reconstr Surg. 2012 Jan;129(1):119-122. doi: 10.1097/PRS.0b013e31823620b0.
Oral incompetence following composite reconstruction of total and subtotal lower lip defects without any functioning lower lip muscle is a difficult problem for reconstructive surgeons. The authors retrospectively reviewed the use of a novel bilateral temporalis suspension technique for oral incompetence following lower lip reconstruction over a 10-year period. The timing of the reconstruction, cause of the defect, period of follow-up, and any complications were noted. Three cases of lower lip resuspension using bilateral temporalis flaps and fascia lata grafts were performed from 2000 to 2010. Two cases were secondary to burn trauma and one was from ballistic trauma. All patients underwent traditional means of reconstruction using free microvascular composite tissue transfer with and without fascial slings. All three patients presented with persistent lower lip incompetence. The average interval between the initial reconstructive operations and the resuspension operations was 1.6 years. All patients achieved dynamic oral competence at the first postoperative visit. At a mean follow-up of 3.6 years, all patients had maintained lower lip function. Dynamic lower lip resuspension with bilateral temporalis flaps and fascia lata grafts is an option for refractory lower lip drooping following total and subtotal loss, especially after conventional static reconstruction and without any functional orbicularis muscle.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
对于重建外科医生来说，全下唇和部分下唇缺损复合重建后出现的口腔功能不全是一个难题，如果没有任何下唇肌肉功能的话。作者回顾性分析了 10 年来使用新型双侧颞肌悬吊技术治疗下唇重建后面部功能不全的情况。记录了重建时间、缺损原因、随访时间以及任何并发症。2000 年至 2010 年间，采用双侧颞肌瓣和阔筋膜移植物进行了 3 例下唇复位术。其中 2 例继发于烧伤，1 例继发于枪弹伤。所有患者均采用游离显微血管复合组织移植术进行传统重建，伴或不伴筋膜吊带。所有 3 例患者均出现持续性下唇功能不全。初次重建手术和复位手术之间的平均间隔为 1.6 年。所有患者在首次术后就诊时均实现了动态口腔功能。平均随访 3.6 年后，所有患者均维持了下唇功能。对于全下唇和部分下唇缺损，尤其是在常规静态重建后且没有任何眼轮匝肌功能的情况下，双侧颞肌瓣和阔筋膜移植物的动态下唇复位术是一种选择。
临床问题/证据水平：治疗，V。
