Chen Wei-Liang, Yang Zhao-Hui, Huang Zhi-Quan, Fan Song, Zhang Da-Ming, Wang You-Yuan
Professor and Director, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Assistant Professor, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
J Oral Maxillofac Surg. 2017 Mar;75(3):622-631. doi: 10.1016/j.joms.2016.08.044. Epub 2016 Sep 13.
Head and neck tumors that involve the craniomaxillofacial region are classified as stage IVb disease and are clinically challenging. In this study, the outcomes of craniofacial resection and craniofacial reconstruction in patients with recurrent malignant tumors involving the craniomaxillofacial region were evaluated.
This retrospective observational study was conducted from January 2008 to August 2015. Data collected for each patient included age, gender, tumor site, initial treatment, craniofacial resection, reconstruction flaps and complications after craniofacial resection, adjuvant treatment, and reported outcomes of craniofacial resection and craniofacial reconstruction. The χ test in SPSS was used to analyze the data.
Twenty-four patients with recurrent malignant tumors involving the craniomaxillofacial region were identified who had undergone craniofacial resection at the Center of Craniomaxillofacial Surgery of Sun Yat-sen University (Guangzhou, Guangdong, China). The study population was comprised of 24 patients (15 men and 9 women; age range, 21 to 73 yr) with recurrent tumors (58.3% with squamous cell carcinoma [SCC], 41.7% with sarcoma [SA]) involving the craniomaxillofacial region who underwent craniofacial resection. Craniofacial resection consisted of orbital exenteration and maxillotomy; anterior skull base surgery, facial resection, and mandibulotomy; or ipsilateral radical neck dissection. The resultant craniomaxillofacial defects were reconstructed using extended vertical lower trapezius island myocutaneous flaps (TIMFs), temporalis myofascial flaps, or submental flaps. All patients with recurrent malignant tumor involving the craniomaxillofacial region underwent gross total resection of the tumor; 22 patients underwent craniofacial reconstruction. There were no major surgical complications. Minor flap failure and wound dehiscence in the donor site occurred in 4 patients. The follow-up period ranged from 8 to 36 months. Seven patients in the SCC group and 7 in the SA group were alive with no evidence of disease (AND), 3 in the SCC group and 2 in the SA group were alive with disease (AWD), and 4 in the SCC and 1 in the SA group died of the disease (DOD) after local recurrence or distant metastases at 8 to 18 months. There were no statistical differences among the AND, AWD, and DOD groups.
Craniofacial resection remains an effective salvage treatment for patients with recurrent SCC and SA involving the craniomaxillofacial region. The extended vertical lower TIMF is a large, simple, and reliable flap for reconstructing major defects after a craniofacial resection.
累及颅颌面区域的头颈部肿瘤被归类为IVb期疾病，临床治疗具有挑战性。本研究评估了复发性恶性肿瘤累及颅颌面区域患者的颅面切除及颅面重建的效果。
本回顾性观察性研究于2008年1月至2015年8月进行。收集的每位患者的数据包括年龄、性别、肿瘤部位、初始治疗、颅面切除、重建皮瓣及颅面切除术后的并发症、辅助治疗，以及报道的颅面切除和颅面重建的结果。使用SPSS中的χ检验分析数据。
在中山大学附属口腔医院颅颌面外科中心，共确定了24例复发性恶性肿瘤累及颅颌面区域且接受了颅面切除的患者。研究人群包括24例患者（15例男性和9例女性；年龄范围21至73岁），其复发性肿瘤（58.3%为鳞状细胞癌[SCC]，41.7%为肉瘤[SA]）累及颅颌面区域并接受了颅面切除。颅面切除包括眶内容摘除术和上颌骨切开术；前颅底手术、面部切除和下颌骨切开术；或同侧根治性颈清扫术。使用延长垂直下斜方肌岛状肌皮瓣（TIMF）、颞肌筋膜瓣或颏下瓣重建由此产生的颅颌面缺损。所有复发性恶性肿瘤累及颅颌面区域的患者均接受了肿瘤全切；22例患者接受了颅面重建。无重大手术并发症。4例患者出现轻微的皮瓣坏死和供区伤口裂开。随访期为8至36个月。SCC组7例患者和SA组7例患者无疾病证据存活（AND），SCC组3例患者和SA组2例患者带瘤存活（AWD），SCC组4例患者和SA组1例患者在局部复发或远处转移后8至18个月死于疾病（DOD）。AND、AWD和DOD组之间无统计学差异。
颅面切除仍然是复发性SCC和SA累及颅颌面区域患者有效的挽救性治疗方法。延长垂直下TIMF是一种用于颅面切除术后重建大的缺损的大的、简单且可靠的皮瓣。
