Hassanein Ahmed Gaber
Maxillofacial Surgery Unit, Faculty of Medicine, Sohag University, Sohag, Egypt.
J Craniofac Surg. 2017 Mar;28(2):e130-e137. doi: 10.1097/SCS.0000000000003323.
Postablative palatomaxillary defects (PAPMDs) represent a challenging reconstructive problem. Temporalis muscle flap (TMF) has been widely used for reconstruction of these defects with minimal morbidity and satisfactory outcome.
To presents the authors' experience in the reconstruction of PAPMDs with TMF and to evaluate the validity of TMF in the reconstruction of such defects.
This prospective study was conducted between July 2011 and July 2016 on selected patients for primary reconstruction of PAPMDs with TMF. Temporalis muscle flaps were assessed during surgery and postoperatively. Patients were followed up to evaluate functional and esthetic outcomes and detect complications.
This study included 32 patients with mean age 48.3 years. The pathology was squamous cell carcinoma in 15 patients (46.9%). Twenty-one patients (65.6%) had type II maxillectomy. Mean time of flap harvesting was 43 minutes. Zygomatic arch osteotomy was done in 3 patients while Coronoid osteotomy in 4 patients. Postoperatively, flaps were viable in 31 patients (96.9%) with good healing of recipient site. Flap epithelization completed within 28 to 59 days. Follow-up period was 13 to 55 months. Satisfactory functional and esthetic outcomes were reported in most of patients with no recurrence. Transient temporal nerve palsy occurred in 2 patients, limited mouth opening in 5 patients. One patient had Transient diplopia with enopthalmos and hypophthalmos. Flap failure occurred in another patient.
Temporalis muscle flap is still a valid reliable and versatile reconstructive tool in palatomaxillary reconstruction after ablative surgery. It has a good cosmetic and functional outcomes and minimal morbidity.
腭上颌切除术后缺损（PAPMDs）是一个具有挑战性的重建问题。颞肌瓣（TMF）已被广泛用于这些缺损的重建，其发病率最低且效果令人满意。
介绍作者使用颞肌瓣重建PAPMDs的经验，并评估颞肌瓣在重建此类缺损中的有效性。
这项前瞻性研究于2011年7月至2016年7月对选定的患者进行，采用颞肌瓣对PAPMDs进行一期重建。在手术中和术后对颞肌瓣进行评估。对患者进行随访，以评估功能和美学效果并检测并发症。
本研究包括32例患者，平均年龄48.3岁。15例患者（46.9%）的病理诊断为鳞状细胞癌。21例患者（65.6%）进行了II型上颌骨切除术。平均取瓣时间为43分钟。3例患者进行了颧弓截骨术，4例患者进行了喙突截骨术。术后，31例患者（96.9%）的皮瓣存活，受区愈合良好。皮瓣上皮化在28至59天内完成。随访期为13至55个月。大多数患者报告功能和美学效果满意，无复发。2例患者出现短暂性颞神经麻痹，5例患者出现张口受限。1例患者出现短暂性复视伴眼球内陷和眼球低位。另1例患者皮瓣失败。
颞肌瓣仍然是腭上颌切除术后重建中一种有效、可靠且通用的重建工具。它具有良好的美容和功能效果，发病率最低。
