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以頦下皮瓣運用於口腔疣狀病變切除後口內缺損之重建

Submental Flap Reconstruction for the Surgical Defect of Oral Cavity Verrucous Lesion

摘要


背景:口腔疣狀病變(包括疣狀增生及疣狀癌)是臨床常見之口腔病灶。手術切除後之缺損常需運用皮瓣來重建。而頦下皮瓣是口內缺損重建的一個選擇。方法:收集於2003年7月至2009年3月間23例以頦下皮瓣重建口腔疣狀病變手術切除後口內缺損之病患,回溯性分析其臨床資料並採討術後併發症、皮瓣適應症及腫瘤安全性問題,評估其優缺點。結果:男性22例,女性l例,病患平均59歲,今3例79歲之高齡病患。病理組織報告疣狀增生6例,疣狀癌17例。腫瘤位置:頰部21例、臼齒後區l例、唇部l例。皮瓣大小由3.5x3.5 cm至8x5 cm。術後20例皮瓣完好無併發症,1例皮瓣完全壞死,2例皮瓣部分壞死(其中l例合併齒齦膿瘍、l例合併血腫)。所有病例皆無口皮瘻管之產生且皆不需救援性重建手術。住院7至25天,平均11天。所有病人均可經口進食,除l例因皮瓣壞死導致輕微帆咽閉鎖不全外,其餘咀嚼吞嚥都正常。語音溝通無障礙。術後無神經之永久性傷害。病患皆追蹤至少兩年,無腫瘤復發現象。結論:頦下皮瓣具厚薄適中、強韌且柔軟、供區隱蔽美觀之特性。且步驟簡單固定、不需顯微重建。其應用多樣性高、成功率高、併發症低,十分適合用於重建口腔疣狀病變切除後之口內缺損。(台耳醫誌 2012;47:42-49)

並列摘要


BACKGROUND: Verrucous lesions such as verrucous hyperplasia or verrucous carcinoma are common oral cavity tumors which are often need to be widely excised. Functional restoration usually requires reconstruction of the surgical defect. Although there are several methods of reconstruction, submental flap is gaining acceptance as another good option.METHODS: From July 2003 to March 2009, 23 patients who underwent wide excision of oral verrucous lesions as well as reconstruction with submental flap, were enrolled for analysis of indications, post-operative complications, and oncological safety. The reliability, benefits and disadvantages of oral defect reconstructions with submental flap were reviewed and discussed.RESULTS: The average age of the 23 patients (22 males and 1 female) was 59 year-old, and 3 of them were 79-year-old. The verrucous lesions included 6 verrucous hyperplasia and 17 verrucous carcinoma located at buccal mucosa (21 cases), retromolar trigone (1 case) and lip (1 case). The flap size varies, from 3.5 × 3.5 cm to 8 × 5 cm. Most flaps (20/23) survived well post-operatively with only one flap necrosis and another two flaps partial necrosis change due to hematoma or gum abscess. There were no orocutaneous fistulas, and no remedial flap reconstructions needed. Hospital stay varies from 7 to 25 days, and the average hospital stay was 11 days. All patients had good oral intake except one with velopharyngeal insufficiency resulting from flap partial necrosis. No articulation problem was noted. No postoperative nerve injury was found. All patients were followed up for at least 2 years and there were no signs of tumor recurrence.CONCLUSION: Submental flap reconstruction has the advantages of proper thickness, flexibility, versatility, good donor site cosmetic appearance, simple operative procedure without microscopic techniques, low morbidity and high success rate. It is a good option for reconstruction of oral cavity defect after verrucous tumor wide excision. (J Taiwan Otolaryngol Head Neck Surg 2012; 47:42-49)

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