Sampathirao Leela Mohan C S R, Thankappan Krishnakumar, Duraisamy Sriprakash, Hedne Naveen, Sharma Mohit, Mathew Jimmy, Iyer Subramania
Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Craniomaxillofac Trauma Reconstr. 2013 Jun;6(2):99-106. doi: 10.1055/s-0033-1343777. Epub 2013 Apr 30.
Background The purpose of this study is to evaluate the outcome of orbital floor reconstruction with free flaps after maxillectomy. Methods This was a retrospective analysis of 34 consecutive patients who underwent maxillectomy with orbital floor removal for malignancies, reconstructed with free flaps. A cross-sectional survey to assess the functional and esthetic outcome was done in 28 patients who were alive and disease-free, with a minimum of 6 months of follow-up. Results Twenty-six patients had bony reconstruction, and eight had soft tissue reconstruction. Free fibula flap was the commonest flap used (n = 14). Visual acuity was normal in 86%. Eye movements were normal in 92%. Abnormal globe position resulted in nine patients. Esthetic satisfaction was good in 19 patients (68%). Though there was no statistically significant difference in outcome of visual acuity, eye movement, and patient esthetic satisfaction between patients with bony and soft tissue reconstruction, more patients without bony reconstruction had abnormal globe position (p = 0.040). Conclusion Free tissue transfer has improved the results of orbital floor reconstruction after total maxillectomy, preserving the eye. Good functional and esthetic outcome was achieved. Though our study favors a bony orbital reconstruction, a larger study with adequate power and equal distribution of patients among the groups would be needed to determine this. Free fibula flap remains the commonest choice when a bony reconstruction is contemplated.
背景 本研究的目的是评估上颌骨切除术后游离皮瓣修复眶底的效果。方法 对34例因恶性肿瘤行上颌骨切除并眶底切除后采用游离皮瓣修复的连续患者进行回顾性分析。对28例存活且无疾病、随访至少6个月的患者进行横断面调查，以评估功能和美学效果。结果 26例患者进行了骨重建，8例进行了软组织重建。游离腓骨瓣是最常用的皮瓣（n = 14）。86%的患者视力正常。92%的患者眼球运动正常。9例患者眼球位置异常。19例患者（68%）美学满意度良好。虽然骨重建和软组织重建患者在视力、眼球运动和患者美学满意度方面的结果无统计学显著差异，但骨重建缺失的患者中眼球位置异常的更多（p = 0.040）。结论 游离组织移植改善了全上颌骨切除术后眶底重建的效果，保护了眼球。获得了良好的功能和美学效果。虽然我们的研究倾向于骨眶重建，但需要进行一项样本量足够大且各组患者分布均衡的更大规模研究来确定这一点。考虑进行骨重建时，游离腓骨瓣仍然是最常用选择。
