- 期刊
Total Soft Palate Reconstruction Using Tri-lobed Radial Forearm Free Flap after Wide Excision-A Case Report
以三葉狀橈側前臂自由皮瓣重建口腔癌術後全軟顎缺損－病例報告
摘要
背景：口咽癌病患中重建軟顎是治療上的一大挑戰，軟齶缺陷會造成言語構音問題和進食時食物從鼻腔返流。於軟顎重建中，須減少顎咽口的大小，才可代償因軟顎缺損所造成的問題。雖然多種方法可用於軟顎重建，術後軟顎功能的恢復仍往往難以獲得滿意的結果。目的及目標：我們期望能恢復接近正常軟顎的解剖構造，並且提供類似閥門的結構，以期能改善術後齶咽閉合不全的問題。材料及方法：一位74歲男性罹患軟顎的鱗狀上皮細胞癌（T3N0M0第III期），接受軟顎腫瘤廣泛性切除以及改良根治性頸淋巴廓清術。我們使用含有大量軟組織的三葉狀橈側前臂自由皮瓣，摺疊成類似新懸雍垂的形狀，並縫合至缺損的部位。結果：術後過程良好。追蹤18個月，達到可接受的吞嚥功能以及可理解的構音表現。結論：因腫瘤切除手術而導致軟顎大面積缺損，以含有大量軟組織三葉狀橈側前臂自由皮瓣重建，對於顎咽閉合功能的恢復可達到令人滿意的結果。因此，用於軟顎大面積缺損的重建，是一個可行的選擇。
關鍵字
無資料並列摘要
Background: Soft palate reconstruction of oropharyngeal cancer is a therapeutic challenge. Speech problem and nasal regurgitation can result from a soft palatal defect. Reduction of the size of the velopharyngeal orifice is required to compensate for the lack of mobility in a reconstructed soft palate. Although various methods can be used for reconstruction of soft palate defects, it is difficult to obtain satisfactory results from the perspective of the functional restoration of the soft palate. Aim and Objectives: We aim to restore the normal palatal anatomy and provide the valve structure to improve postoperative velopharyngeal insufficiency. Materials and Methods: A case of a 74-year-old male with soft palate squamous cell carcinoma (T3N0M0 stage III) underwent wide excision and modified radical neck dissection. A large volume of tri-lobed radial forearm free flap (RFFF) was folded like neo-uvula and inset the defect. Results: The postoperative course was uneventful, within 18 months, and he was able to tolerate swallowing function and exhibited understandable speech quality. Conclusion: Tri-lobed RFFF reconstruction for large soft palate defect after oncologic surgery resulted in satisfactory prognosis for restore velopharyngeal function and it was a feasible option for large soft palate defect reconstruction.