Mericli Alexander F, Friedstat Jonathan S, Chang Edward I, Hanasono Matthew M
Department of Plastic Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
Microsurgery. 2017 Mar;37(3):243-247. doi: 10.1002/micr.30129. Epub 2017 Mar 13.
Simultaneous maxillary and mandibular reconstruction is exceedingly rare. These are complicated cases, requiring consideration of multiple variables: defect components, donor site morbidity, recipient vessels, and so forth. We describe a unique case of secondary maxillary/mandibular reconstruction in a 59-year-old male. The original defect was created after removal of a buccal squamous cell carcinoma, involving the external cheek skin, buccal mucosa, right mandibular body, and right inferior maxilla; a free vertical rectus abdominis musculocutaneous flap was used for the initial reconstruction. At the time of presentation to our clinic, the patient was tube-feed-dependent, unable to speak, and distressed regarding his appearance. We revised his reconstruction, rebuilding his maxilla and hemimandible using two free fibula flaps from a single fibula. The fibulae were vascularized via vein grafts and an ALT flap was used for external cheek resurfacing. All flaps survived and there were no complications at seven months since his surgery (when this report was written). The patient had intelligible speech and maintained adequate nutrition with a soft diet. Simultaneous vascularized bony reconstruction of the maxilla and mandible using a single fibula flap may be performed safely and with good outcomes.
同时进行上颌骨和下颌骨重建极为罕见。这些都是复杂的病例，需要考虑多个变量：缺损组成部分、供区并发症、受区血管等等。我们描述了一例59岁男性继发性上颌骨/下颌骨重建的独特病例。最初的缺损是在切除颊部鳞状细胞癌后形成的，累及颊部外侧皮肤、颊黏膜、右下颌骨体和右下颌骨；最初的重建使用了游离垂直腹直肌肌皮瓣。在患者前来我们诊所就诊时，他依赖鼻饲管进食，无法说话，且对外表感到苦恼。我们对他的重建进行了修订，使用来自单一腓骨的两个游离腓骨瓣重建了他的上颌骨和半侧下颌骨。腓骨通过静脉移植进行血管化，并使用一个股前外侧皮瓣进行颊部外侧皮肤修复。所有皮瓣均存活，自手术以来七个月（撰写本报告时）无并发症发生。患者能够清晰讲话，通过软食维持了充足的营养。使用单一腓骨瓣同时对上颌骨和下颌骨进行带血管蒂骨重建可以安全地进行，并且效果良好。
