Boro Sumanjit, Sahewalla Ashutosh, Kakati Kaberi, Das Anupam
Dr B Borooah Cancer Insitute, House no. 15, 4th floor, Nalini Bala Devi path, Sublane 2, Sreenagar, Guwahati, Assam 781005 India.
Indian J Otolaryngol Head Neck Surg. 2022 Dec;74(Suppl 3):4688-4693. doi: 10.1007/s12070-021-03000-1. Epub 2022 Jan 11.
Reconstructions of the maxillary defect after tumor resection are challenging surgeries. Maxillary reconstructions are done using obturators, locoregional flaps and free tissue transfers. Free flap options available for maxillary reconstruction are radial forearm, anterolateral thigh free flap, free fibular osteocutaneous flap, rectus abdominis myocutaneous flap, scapular, and iliac crest osteomyocutanous free flap etc. This is a single institutional observational study conducted at a tertiary cancer centre in North East India from May 2018 to April 2019. All the reconstructions are done with free tissue transfer. Post-operative outcome was assessed with University of Washington Quality of Life Questionnaire (UW-QOL v4.1). Data was collected from patient records and hospital online reporting system. All data were analysed using SPSS (statistical package for social sciences) version 21. Brown's classification was used to classify maxillary defects in this study. A value ≤ 0.05 was considered statistically significant. In our study, we included fourteen patients (n = 14), of which anterolateral thigh free flap was used for reconstruction in thirteen cases and in one case free fibular osteocutaneous flap was done. Mean age is 33.36 ± 14 years; there was two flap failure. Flap failure is associated with a statistically significant low swallowing and appearance score (p value is 0.036 for both). The orbital exenteration is associated with low appearance score but it is not statistically significant (p value 0.70), probably due to small sample size in the series. Our early experience of free tissue transfer in maxillary reconstruction is satisfactory in terms of quality of life of the patient as well as the oncological outcome. With positive initial experience in maxillary reconstruction with free flaps large study population will be considered in near future.
肿瘤切除术后上颌骨缺损的重建是具有挑战性的手术。上颌骨重建可采用赝复体、局部皮瓣和游离组织移植。可用于上颌骨重建的游离皮瓣选择包括桡侧前臂皮瓣、股前外侧游离皮瓣、游离腓骨骨皮瓣、腹直肌肌皮瓣、肩胛皮瓣和髂嵴骨肌皮游离皮瓣等。这是一项在印度东北部一家三级癌症中心于2018年5月至2019年4月进行的单机构观察性研究。所有重建均采用游离组织移植。术后结果采用华盛顿大学生活质量问卷（UW-QOL v4.1）进行评估。数据从患者记录和医院在线报告系统收集。所有数据均使用社会科学统计软件包（SPSS）21版进行分析。本研究采用布朗分类法对上颌骨缺损进行分类。P值≤0.05被认为具有统计学意义。在我们的研究中，纳入了14例患者（n = 14），其中13例采用股前外侧游离皮瓣进行重建，1例采用游离腓骨骨皮瓣。平均年龄为33.36±14岁；有2例皮瓣失败。皮瓣失败与吞咽和外观评分在统计学上显著降低相关（两者P值均为0.036）。眼眶内容剜除术与外观评分降低相关，但无统计学意义（P值0.70），可能由于该系列样本量较小。就患者的生活质量以及肿瘤学结果而言，我们在上颌骨重建中进行游离组织移植的早期经验是令人满意的。鉴于游离皮瓣在上颌骨重建中的初步积极经验，在不久的将来将考虑纳入更大的研究人群。
