DeSisto Nicole G, Verducci Chloe, Pittman Amy L, Yang Shiayin F
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Loyola University Medical Center, Chicago, IL, USA.
Ann Otol Rhinol Laryngol. 2025 Apr;134(4):281-283. doi: 10.1177/00034894241302133. Epub 2024 Nov 22.
Surgical management of head and neck cancer (HNC) can result in significant functional deficits. Large tumors of the oral cavity may require extensive resection and the need for microvascular free-flap reconstruction involving the use of adynamic tissue. This may result in oral incompetence, drooling, and unsatisfactory esthetic outcomes. Maintenance of the orbicularis oris and function of the oral sphincter are important objectives in the reconstruction of large defects. When this cannot be accomplished, secondary local flaps can be employed to restore the orbicularis oris.
We present 2 cases of oral incompetence following microvascular free- flap reconstruction for large resections of HNC.
All cases were managed with debulking of flap, modified Karapandzic flaps, and advancement of composite skin, muscle, and buccal mucosa to restore the function of the oral sphincter and improve oral competence. The surgical techniques demonstrated in our cases resulted in improvement in both functional and esthetic outcomes.
Restoring continuity of the orbicularis oris muscle is a critical functional and esthetic consideration in microvascular free flap reconstruction where the lip is involved or disrupted. However, when this cannot be achieved, restoration of the oral sphincter and oral commissure can be achieved with a secondary reconstructive procedure.
头颈部癌（HNC）的手术治疗可能会导致明显的功能缺陷。口腔大肿瘤可能需要广泛切除，并需要使用无活力组织的微血管游离皮瓣重建。这可能会导致口轮匝肌功能不全、流口水以及美学效果不佳。在重建大的缺损时，维持口轮匝肌和口腔括约肌的功能是重要目标。当无法实现这一点时，可以采用二期局部皮瓣来修复口轮匝肌。
我们报告2例因HNC大切除术后微血管游离皮瓣重建导致口轮匝肌功能不全的病例。
所有病例均通过皮瓣减容、改良Karapandzic皮瓣以及复合皮肤、肌肉和颊黏膜推进来治疗，以恢复口腔括约肌的功能并改善口轮匝肌功能不全。我们病例中展示的手术技术在功能和美学效果上均有改善。
在涉及或破坏唇部的微血管游离皮瓣重建中，恢复口轮匝肌的连续性是关键的功能和美学考量。然而，当无法实现这一点时，可通过二期重建手术恢复口腔括约肌和口角。
