Conley J, Sachs M E, Parke R B
Otolaryngol Head Neck Surg. 1982 Jan-Feb;90(1):58-68. doi: 10.1177/019459988209000111.
Rehabilitation of major resections of the tongue has always posed a serious problem. This paper presents the feasibility and rational of rehabilitating partial glossectomies by the use of the pectoralis major myocutaneous flap and the fabrication of a "new tongue" by the use of this flap. The criteria for these techniques in benign and malignant tumors of the tongue are outlined. The segmental innervation of the pectoralis major muscle from a variety of three to five nerve branches permits the development of a skin-muscle flap that may be transposed with its nerve supply intact or totally denervated, depending upon the status of the hypoglossal nerves and tongue in the operative field. This presents the possibility of transposing a skin-muscle flap into a glossal wound with a completely intact nerve supply where the new flap is under constant instruction in its new physiologic environment. It also presents the possibility of neurotization of the denervated section of the muscle flap by axones from the intact segment of tongue. A third possibility is the fabrication of a "new tongue" by the transfer of the hypoglossal nerves into the denervated segment of the peripheral aspect of the myocutaneous flap. This variety and combination of rehabilitative techniques introduces a new phase into the rehabilitation of the tongue.
舌大部切除术的修复一直是个严重问题。本文介绍了使用胸大肌肌皮瓣修复部分舌切除术的可行性及合理性，以及利用该皮瓣制作“新舌”的方法。概述了这些技术在舌部良性和恶性肿瘤中的应用标准。胸大肌由三到五支神经分支进行节段性支配，这使得可以制作一种皮肌瓣，根据手术野中舌下神经和舌的情况，该皮肌瓣可以在神经供应完整的情况下进行转移，也可以完全去神经支配后转移。这就提供了将皮肌瓣转移至舌创面且神经供应完全完整的可能性，在此情况下，新皮瓣在其新的生理环境中能持续接受指令。这还提供了舌完整节段的轴突对肌瓣失神经部分进行神经化的可能性。第三种可能性是将舌下神经转移至肌皮瓣周边失神经节段来制作“新舌”。这种多样且组合的修复技术为舌部修复开启了一个新阶段。
