Bande Chandrashekhar, Joshi Ajit, Gawande Mayur, Tiwari Manish, Rode Vijay
Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, 440024, India.
Oral Maxillofac Surg. 2018 Mar;22(1):45-51. doi: 10.1007/s10006-017-0665-7. Epub 2017 Nov 23.
Various surgical modalities have been advocated for the soft tissue reconstruction of oral cavity with variable results. This prospective study evaluates the utility of platysma myocutaneous flap (PMF) in the reconstruction of surgical defects followed by treatment of oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) in terms of healing and functional outcomes.
In this prospective study, 47 patients with OSMF and 15 of OSCC were evaluated and selected for PMF reconstruction. OSCC was selected under TNM category only. Patients were operated under general anaesthesia followed by PMF grafting. In OSCC, ipsilateral and for OSMF, bilateral PMF was used.
In 47 patients treated for OSMF, 46 were male and 1 female while 15 cases of OSCC, 10 were male and 5 females aged between 18 and 44 years. Intraoperative mouth opening was achieved up to 48 mm in OSMF followed by 42.5 mm postoperatively after 2 years. However, uneventful healing and acceptable scar on cervical region was noted in all the cases including OSCC. In OSMF, three cases of dehiscence, four partial necrosis at end of flap and in OSCC one case shows skin loss at flap and two partial necrosis at tip of flap and extraoral localised abscess at ipsilateral donor site in one case was noted. An uneventful healing, anatomical form and functional results were restored with acceptable scarring at donor site without any evidence of difficulty in neck movements were observed.
The PMF is simple, versatile and could be valued as a reconstructive alternative, with interesting visual qualities. It is a good therapeutic alternative tool for reconstruction of the buccal mucosa, especially for small- and medium-sized defects between 2 and 4 cm of the oral cavity.
人们提倡采用各种手术方式对口腔软组织进行重建，但其效果各异。这项前瞻性研究评估了颈阔肌肌皮瓣（PMF）在手术缺损重建中的效用，以及在治疗口腔黏膜下纤维化（OSMF）和口腔鳞状细胞癌（OSCC）后的愈合和功能结果。
在这项前瞻性研究中，对47例OSMF患者和15例OSCC患者进行了评估，并选择他们进行PMF重建。仅在TNM分类下选择OSCC患者。患者在全身麻醉下接受手术，随后进行PMF移植。对于OSCC，采用同侧PMF；对于OSMF，则采用双侧PMF。
在47例接受OSMF治疗的患者中，46例为男性，1例为女性；而在15例OSCC患者中，10例为男性，5例为女性，年龄在18至44岁之间。OSMF患者术中张口度可达48毫米，术后2年为42.5毫米。然而，包括OSCC患者在内的所有病例在颈部区域均实现了愈合良好且瘢痕可接受。在OSMF患者中，有3例出现裂开，4例在皮瓣末端出现部分坏死；在OSCC患者中，1例皮瓣处出现皮肤缺失，2例皮瓣尖端出现部分坏死，1例同侧供区出现口外局限性脓肿。所有患者均实现了愈合良好，恢复了解剖形态和功能，供区瘢痕可接受，未观察到颈部活动困难的迹象。
PMF操作简单、用途广泛，可作为一种具有良好视觉效果的重建替代方案。它是颊黏膜重建的良好治疗替代工具，尤其适用于口腔2至4厘米的中小型缺损。
