Cheng L, Wu H T, Tao L, Li X M, Zhou L
Department of Otorhinolaryngology, Otolaryngological Hospital Affiliated to Fudan University，Shanghai, 200031,China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Mar 20;31(6):415-418. doi: 10.13201/j.issn.1001-1781.2017.06.002.
To explore the reconstruction methods of oropharyngeal defects after resection of tonsillar cancer by mandibular swing approach.Twenty four cases of patients with tonsillar carcinoma hospitalized in our institution from January, 2010 to December, 2015 were analyzed. Based on the degree and extent of tissue defects, they were divided into three categories.①Small defects, including loss of tonsillar fossa and pharyngeal arches; ②Moderate defects, including small defects of soft palate or tongue root besides lateropharyngeal defects; ③Large defects, including large defects of soft palate and tongue root besides lateropharyngeal defects. The tissue defects of 8 patients belonged to small defects, of whom 4 cases were repaired with mid-thick skin and the others were restored by radial forearm flaps. There were 5 cases of patients with moderate oropharyngeal defects after surgery of tonsillar carcinoma. These defects were reconstructed by radial forearm flaps(2 cases) and anterolateral femoral skin flaps (3 cases) respectively, while the remaining large defects of 11 patients were renovated using pectoralis major myocutaneous flaps(9 cases) and anterolateral femoral skin flaps(2 cases). All the patients healed by first intention after surgery.Four transplanted skin grafts on the regions of small defects survived completely.5 cases of radial forearm flaps and anterolateral femoral skin flaps also survived well, whereas only one radial forearm flap suffered from vascular crisis leading to failure at 5 days postoperatively. The necrotic flaps were then removed by submaxillary space and oral cavity and the wounds were self-healed. The tissue defects were successfully repaired by pectoralis major myocutaneous flaps. Although the surgical wounds swelled, they were obviously relieved half a year later. In the tonsillar cancer patients encroached on soft palates, one occurred nasopharyngeal reflux and 3 spoke vaguely but understandably. The other patients' function of chewing, deglutition, respiration and speech were restored well. Small defects after resection by mandibular swing approach could be repaired by mid-thick skin or radial forearm flaps. Moderate defects of T3 tonsillar cancer could be restored using radial forearm flaps or anterolateral femoral skin flaps, while anterolateral femoral skin flaps or pectoralis major myocutaneous flaps could reconstructed the large defects of T3 or T4 tonsillar cancer.
探讨下颌骨摆动入路切除扁桃体癌后口咽缺损的修复方法。分析2010年1月至2015年12月在我院住院的24例扁桃体癌患者。根据组织缺损的程度和范围，将其分为三类。①小缺损，包括扁桃体窝和咽弓缺失；②中度缺损，包括除咽侧壁缺损外的软腭或舌根小缺损；③大缺损，包括除咽侧壁缺损外的软腭和舌根大缺损。8例患者的组织缺损属于小缺损，其中4例采用中厚皮片修复，其余采用桡侧前臂皮瓣修复。扁桃体癌手术后有5例患者出现中度口咽缺损。这些缺损分别采用桡侧前臂皮瓣（2例）和股前外侧皮瓣（3例）修复，其余11例大缺损采用胸大肌肌皮瓣（9例）和股前外侧皮瓣（2例）修复。所有患者术后均一期愈合。小缺损区域的4块移植皮片全部存活。5例桡侧前臂皮瓣和股前外侧皮瓣也存活良好，而仅1例桡侧前臂皮瓣术后5天发生血管危象导致失败。坏死皮瓣经颌下间隙和口腔切除，伤口自行愈合。胸大肌肌皮瓣成功修复了组织缺损。虽然手术伤口肿胀，但半年后明显减轻。在侵犯软腭的扁桃体癌患者中，1例出现鼻咽反流，3例说话含糊但可理解。其他患者的咀嚼、吞咽、呼吸和言语功能恢复良好。下颌骨摆动入路切除后的小缺损可用中厚皮片或桡侧前臂皮瓣修复。T3扁桃体癌的中度缺损可用桡侧前臂皮瓣或股前外侧皮瓣修复，而股前外侧皮瓣或胸大肌肌皮瓣可修复T3或T4扁桃体癌的大缺损。
