Devauchelle B, Testelin S, Bonan C, Souaid G
Service de Chirurgie Maxillofaciale, CHU, Amiens.
Rev Stomatol Chir Maxillofac. 1998 Jul;99 Suppl 1:22-37.
There are two pitfalls to be avoided in transmandibular buccopharyngectomy: mandibular amputation and inversely a contemplative wait-and-see attitude. Preservative measures require a precise evaluation of bone invasion, surgical approaches respecting the lip and cutaneo-muscular flaps, and an early assessment of the secondary effects of radiotherapy. Reasonable use of bone periosteal free flaps and striving for immediate reconstruction of each defect certainly leads to an interventionist behavior, but which can be conducted under better conditions and more attainable objectives than after mandibular deformation, a pharyngostomia or recent radionecrosis. Microsurgical procedures are nothing more than technical mastery and can lead to arrogant behavior. Fifty cases illustrate this position.
下颌骨截断以及相反地采取观望的保守态度。保全性措施需要对骨侵犯进行精确评估，采用尊重唇部和皮肌瓣的手术入路，并对放疗的继发效应进行早期评估。合理使用骨膜游离瓣并争取对每个缺损进行即刻重建肯定会导致积极干预的行为，但这种行为在比下颌骨变形、咽造口或近期放射性坏死更好的条件下、更可实现的目标下进行。显微外科手术只不过是技术掌握，可能导致傲慢行为。五十个病例说明了这一观点。
