Fan T F, Ye Y X, Wang Q, Yang Z M, Dai B W, Zhang S, Wu H J
Department of Oral and Maxillofacial Surgery, the Second Xiangya Hospital of Central South University, , Changsha 410011, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Apr 7;56(4):369-373. doi: 10.3760/cma.j.cn115330-20200918-00755.
To study the effects of superficial temporal artery and vein as recipient vessels for the free anterolateral thigh flap on the appearance and functions after maxillectomy. Clinical data of 21 patients with malignant maxillary tumors in Department of Oral and Maxillofacial Surgery, the Second Xiangya Hospital of Central South University from January 2014 to November 2019, who were treated by free anterolateral thigh flap with temporal superficial vessels as the recipient vessels were analyzed retrospectively. There were 18 males and 3 females, with the age ranging from 29 to 73 years old, including 19 cases of squamous carcinoma, 1 case of adenoid cystic carcinoma and 1 case of osteosarcoma. Of those 7 patients underwent primary surgery, 14 patients received resurgery, and 6 patients had a history of postoperative radiotherapy and chemotherapy. Among 14 patients with resurgery, 13 had recurrent ipsilateral second site tumor and 1 had recurrent tumor, and all of them received the maxillectomy and reconstructive surgery with the free anterolateral thigh flap. Patients were evaluated with water swallow test and speech intelligibility score in 1, 3 and 6 months after operation. The data were statistically analyzed with SPSS 22.0 statistical software. Water swallow test results before and after operation were compared using the Wilcoxon rank sum test. The mean speech intelligibility scores before and after operation were compared by the paired test. Patients were followed up for 10-60 months. All free flaps survived after operation. No diplopia occurred. Breathing, swallowing and speaking functions were normal. No movement disorders caused by the donor of thigh flap. Water swallow test showed no phenomenon of water flowing into the nasal cavity or oral and nasal leakage with level Ⅰ for 4 cases, level Ⅱ for 13 cases, level Ⅲ for 3 cases and level Ⅳ for 1 case. The mean speech intelligibility scores before surgery and 1, 3 and 6 months after surgery were 4.31±0.13, 1.46±0.21, 2.15±0.45 and 2.87±0.76 respectively. There was statistically significant difference in the mean speech intelligibility scores between 1 and 6 months after surgery (=78.456, <0.05). It is safe and reliable to use the superficial temporal vessels as recipient vessels for free anterolateral thigh flap in the reconstruction of defect after maxillectomy in malignant tumors, with good outcomes of functions and a satisfactory restoration of outward appearance.
探讨颞浅动静脉作为游离股前外侧皮瓣受区血管在颌骨切除术后对外观及功能的影响。回顾性分析2014年1月至2019年11月中南大学湘雅二医院口腔颌面外科收治的21例上颌恶性肿瘤患者的临床资料，这些患者均采用以颞浅血管为受区血管的游离股前外侧皮瓣进行治疗。其中男性18例，女性3例，年龄29～73岁，包括鳞状细胞癌19例、腺样囊性癌1例、骨肉瘤1例。7例患者接受初次手术，14例患者接受再次手术，6例患者有术后放化疗史。14例再次手术患者中，13例为同侧复发性第二部位肿瘤，1例为复发性肿瘤，均接受了颌骨切除及游离股前外侧皮瓣修复重建手术。术后1、3、6个月对患者进行饮水试验及语音清晰度评分评估。采用SPSS 22.0统计软件进行统计学分析。手术前后饮水试验结果采用Wilcoxon秩和检验进行比较。手术前后平均语音清晰度评分采用配对t检验进行比较。对患者进行10～60个月的随访。术后所有游离皮瓣均存活。未出现复视。呼吸、吞咽及说话功能正常。未出现因股部皮瓣供区导致的运动障碍。饮水试验显示，4例为Ⅰ级，无鼻腔流水或口鼻漏现象；13例为Ⅱ级；3例为Ⅲ级；1例为Ⅳ级。术前及术后1、3、6个月平均语音清晰度评分分别为4.31±0.13、1.46±0.21、2.15±0.45、2.87±0.76。术后1～6个月平均语音清晰度评分差异有统计学意义（t=78.456，P<0.05）。在恶性肿瘤颌骨切除术后缺损修复中，采用颞浅血管作为游离股前外侧皮瓣的受区血管安全可靠，功能恢复良好，外观修复满意。
