Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Xiang, Eastern District, Beijing, 100730, China.
Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing, 100730, China.
Eur Arch Otorhinolaryngol. 2023 Dec;280(12):5507-5518. doi: 10.1007/s00405-023-08131-5. Epub 2023 Aug 2.
To explore the feasibility of making a submental perforator flap distal to the connecting line between the mastoid and the sternoclavicular joint under the guidance of neck-enhanced CT and repairing the postoperative defect of upper airway malignancy.
This study retrospectively analysed 19 cases of upper airway malignant tumours treated in our department from January 2021 to September 2022, including 17 males and 2 females, aged 43-70 years.
15 cases were in the laryngopharynx, 2 cases in the nasal cavity and paranasal sinus and 2 cases on the soft palate. All the lesions were malignant and at stages TNM.
The extended submental perforator flap (size 22-15 × 6-7 cm) was prefabricated distal to the connecting line between the mastoid and the sternoclavicular joint. After tumour resection, the flap was used to repair the postoperative defect. Fifteen cases of laryngopharyngeal malignant tumours were repaired using the extended submental perforator flap with the vascular pedicle located on the opposite side of the tumour body. Two cases of nasal cavity and paranasal sinus tumours were repaired using the extended submental perforator flap combined with the temporalis muscle flap. The soft palate was completely removed in two patients with soft palate cancer and repaired using the folded extended submental perforator flap.
Before the surgery, the reflux vein was observed by neck-enhanced CT, including 12 cases returning to the internal jugular vein and 7 cases to the external jugular vein. All 19 cases in which flaps were used survived, and 1 case had a postoperative infection. All the patients had nasal feeding removed after surgery. The tracheal cannula was removed from the patients with laryngeal preservation, and the pronunciation was satisfactory. Among them, patients with soft palate cancer repair had mild nasal reflux symptoms with smooth breathing. During the follow-up period of 4-24 months, 18 patients had no tumour recurrence or metastasis, and 1 patient had cervical lymph node metastasis.
This study highlights the use of a submental perforator flap distal to the connecting line between the mastoid and the sternoclavicular joint to repair postoperative defects for upper airway malignancy as an innovative surgical approach that provides more tissue and good arteriovenous blood supply to adjacent sites. This method has high clinical value and provides an effective option for repairing postoperative defects of upper airway malignancy.
在颈部增强 CT 引导下，探讨制备胸锁乳突肌连线下方颏下穿支皮瓣，修复上气道恶性肿瘤术后缺损的可行性。
回顾性分析 2021 年 1 月至 2022 年 9 月本科收治的 19 例上气道恶性肿瘤患者的临床资料，男 17 例，女 2 例；年龄 43~70 岁。
喉咽部 15 例，鼻腔及鼻窦 2 例，软腭 2 例。所有病变均为恶性，TNM 分期均为Ⅲ~Ⅳ期。
于胸锁乳突肌连线下方预制成颏下穿支皮瓣（大小 2215 cm×67 cm）。肿瘤切除后，应用皮瓣修复术后缺损。喉咽部恶性肿瘤 15 例采用带蒂对侧穿支皮瓣修复，2 例鼻腔及鼻窦肿瘤采用带蒂颏下穿支皮瓣联合颞肌瓣修复，2 例软腭裂患者行全软腭裂切除，折叠式带蒂颏下穿支皮瓣修复。
术前颈部增强 CT 观察反流静脉，12 例回流至颈内静脉，7 例回流至颈外静脉。19 例皮瓣均成活，1 例术后感染。所有患者术后均拔除鼻饲管。行喉保留术的患者拔除气管套管，发音满意。其中行软腭裂修复的患者有轻度鼻腔反流症状，呼吸通畅。随访 4~24 个月，18 例患者无肿瘤复发或转移，1 例出现颈淋巴结转移。
本研究采用胸锁乳突肌连线下方颏下穿支皮瓣修复上气道恶性肿瘤术后缺损，为一种创新性的手术方法，可为邻近部位提供更多的组织和良好的动静脉血供，具有较高的临床应用价值，为上气道恶性肿瘤术后缺损的修复提供了有效的选择。
