Karakawa Ryo, Narushima Mitsunaga, Ogishima Shinya, Hara Hisako, Karino Shotaro, Iida Takuya, Kakigi Akinobu, Koshima Isao
Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
Department of Plastic and Reconstructive Surgery, The Mie University, Mie, Japan.
SAGE Open Med Case Rep. 2017 Nov 16;5:2050313X17741825. doi: 10.1177/2050313X17741825. eCollection 2017.
The complex reconstruction of nerves and soft tissue in the head and neck region is still challenging, especially in cases requiring external auditory canal reconstruction with facial nerve reconstruction. We report a case of left facial schwannoma extending into the external auditory canal beyond the tympanic membrane with facial paralysis in which the reconstruction of both the facial nerve and external auditory canal was successfully performed using an anterolateral thigh flap as a super-thin full-thickness skin flap, including vascularized lateral femoral cutaneous nerve. Resection of 20 mm × 46 mm facial schwannoma, including the skin of the external auditory canal, tympanic membrane, incus and malleus, was performed. The 8-cm nerve gap was repaired using a vascularized lateral femoral cutaneous nerve included in the anterolateral thigh flap. An 8 cm × 2 cm super-thin, free anterolateral thigh flap was then rolled up as a sac (diameter of 2 cm, height of 2 cm) and inset to the external auditory canal defect. The postoperative course was uneventful, and the flap survived completely. One year and nine months after the surgery, the patient's facial movement has improved to the pre-surgery level.
头颈部神经和软组织的复杂重建仍然具有挑战性，尤其是在需要进行外耳道重建并同时重建面神经的情况下。我们报告了一例左侧面神经鞘瘤延伸至鼓膜以外的外耳道并伴有面瘫的病例，在该病例中，使用股前外侧皮瓣作为超薄全厚皮瓣（包括带血管的股外侧皮神经）成功地进行了面神经和外耳道的重建。切除了20毫米×46毫米的面神经鞘瘤，包括外耳道皮肤、鼓膜、砧骨和锤骨。使用股前外侧皮瓣中包含的带血管股外侧皮神经修复了8厘米的神经缺损。然后将一个8厘米×2厘米的超薄游离股前外侧皮瓣卷成一个囊（直径2厘米，高2厘米），并植入外耳道缺损处。术后过程顺利，皮瓣完全存活。手术后一年零九个月，患者的面部运动已恢复到术前水平。
