Chou Chieh, Chen Chien-Chang, Lai Chung-Sheng, Lin Sin-Daw, Kuo Yur-Ren
Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Microsurgery. 2017 Oct;37(7):831-835. doi: 10.1002/micr.30221. Epub 2017 Sep 12.
Oral cancers associated with submucosal fibrosis-induced trismus are common. They may affect the patients' quality of life, cause nutritional deficits, and interfere with postoperative cancer surveillance. In such cases, locating desirable recipient vessels in the head and neck can be difficult. This report presents a 47-year-old man with severe trismus caused by recurrent head and neck cancer, who had received multiple free-flap reconstructions after cancer ablation. Reconstruction was successfully achieved for the bilateral defects and releasing the trismus by using simultaneous double free radial forearm flaps as a chained flow-through pattern with one residual recipient vessel combined with the bilateral myotomy of the medial pterygoid and masseter muscles, and coronoidectomy. Both flaps survived without any postoperative complication. The maximal mouth opening measured by interincisal distance was 38 mm intraoperative and 32 mm during the 3-year follow-up period. This approach may be an effective option for releasing trismus when recipient vessels are lacking.
与黏膜下纤维化引起的牙关紧闭相关的口腔癌很常见。它们可能会影响患者的生活质量，导致营养缺乏，并干扰术后癌症监测。在这种情况下，在头颈部找到合适的受区血管可能很困难。本报告介绍了一名47岁因复发性头颈癌导致严重牙关紧闭的男性患者，该患者在癌症切除术后接受了多次游离皮瓣重建。通过使用双侧游离桡侧前臂皮瓣以链式流通模式、一根残余受区血管并结合翼内肌和咬肌双侧肌切开术以及冠突切除术，成功修复了双侧缺损并缓解了牙关紧闭。两个皮瓣均存活，无任何术后并发症。术中通过切牙间距离测量的最大开口度为38毫米，在3年随访期间为32毫米。当缺乏受区血管时，这种方法可能是缓解牙关紧闭的有效选择。
