Zhang H K, Sun X C, Yu H P, Liu Q, Gu Y, Xue K, Li W P, Wang D H, Yu H M
Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China.
Department of Neurosurgery, Eye & ENT Hospital, Fudan University, Shanghai 200031, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Nov 7;57(11):1282-1287. doi: 10.3760/cma.j.cn115330-20210806-00532.
To summarize the application of temporalis muscle flap in the salvage nasopharyngectomy for advanced recurrent nasopharyngeal carcinoma (rNPC), and to provide guidance for the repair of extensive skull base defects in salvage rNPC. A total of 54 patients with the application of temporalis muscle flap in the salvage nasopharyngectomy for advanced rNPC were retrospectively analyzed, including 42 males and 12 females, aging from 29 to 71 years. There were 36 patients with rT3 and 18 patients with rT4. The surgical methods of temporalis muscle flap repair were summarized. The general situation, survival time and postoperative complications of patients were recorded, and the advantages and disadvantages of temporalis muscle flap were discussed. The temporal muscle flap could completely cover the defect area of nasopharynx and skull base, without the need for other autologous repair materials. The follow-up period was 2 to 28 months. The survival rate of temporalis flap was 98.1% (53/54). The 1-year overall survival rate was 84.5% while 1-year progression-free survival rate was 49.0%. None of the patients had facial nerve injury. Three patients (5.6%) had necrosis of the cranial membrane required surgical intervention and four patients (7.4%) required a chonoplasty due to severe chonostril stenosis or chonostril atresia. Eleven cases (20.4%) had mouth opening restriction, chewing weakness, dysphagia and other eating difficulties. Temporalis muscle flap is an alternative flap for the salvage nasopharyngectomy for advanced rNPC. Temporal muscle flap shows high survival rate and wide coverage, but the surgeon should apprehend the possible complications and reduce the occurrence of them.
总结颞肌瓣在晚期复发性鼻咽癌（rNPC）挽救性鼻咽癌切除术中的应用情况，为挽救性rNPC广泛颅底缺损的修复提供指导。回顾性分析54例在晚期rNPC挽救性鼻咽癌切除术中应用颞肌瓣的患者，其中男性42例，女性12例，年龄29至71岁。rT3患者36例，rT4患者18例。总结颞肌瓣修复的手术方法。记录患者的一般情况、生存时间及术后并发症，并探讨颞肌瓣的优缺点。颞肌瓣可完全覆盖鼻咽和颅底的缺损区域，无需其他自体修复材料。随访时间为2至28个月。颞肌瓣成活率为98.1%（53/54）。1年总生存率为84.5%，1年无进展生存率为49.0%。所有患者均未发生面神经损伤。3例患者（5.6%）出现硬脑膜坏死需手术干预，4例患者（7.4%）因严重鼻瓣狭窄或闭锁需行鼻成形术。11例患者（20.4%）出现张口受限、咀嚼无力、吞咽困难等进食困难情况。颞肌瓣是晚期rNPC挽救性鼻咽癌切除术的一种可供选择的皮瓣。颞肌瓣成活率高、覆盖范围广，但手术医生应了解可能出现的并发症并减少其发生。
