Combined Nasolabial Flap and Z-Plasty for Trismus Release and Mouth Angle Reconstruction-A Report of Two Cases and Literature Review

合併鼻唇溝皮瓣和Z形整形術矯正牙關緊閉併嘴角重建－兩病例報告及文獻回顧

陳志軒(Chih-Hsuan Chen) ； 陳建璋(Chien-Chang Chen) ； 簡雄飛(Hsiung-Fei Chien) ； 鄭乃禎(Nai-Chen Cheng)

《臺灣整形外科醫學會雜誌》 24卷1期 (2015/03) Pp. 69-76

摘要

背景：一個人的外觀或是功能上，嘴唇及其周圍的組織佔有重要的角色；兩者的重建通常帶給外科醫師困難的挑戰。以往文獻的報告已經描述了許多方法去解決牙關緊閉與嘴角攣縮的問題。然而，有時局部皮瓣不足以覆蓋整個缺陷，而顯微血管皮瓣可提供豐富的軟組織材料，但它們需要冗長治療過程，而且還必須負擔皮瓣失敗的風險。目的及目標：在此我們提出一個替代的方法，合併鼻唇溝皮瓣和Z形整形術來矯正牙關緊閉並重建嘴角，以局部的皮瓣來解決這個棘手的臨床問題。材料及方法：因腫瘤切除手術造成牙關緊閉和嘴角疤痕攣縮的兩位病患接受鼻唇溝皮瓣和Z形整形手術，重建嘴角並改善牙關緊閉的症狀。結果：在釋放攣縮組織後，我們分離出鼻唇溝皮瓣並使之轉位來重建嘴角以及頰黏膜缺損。同時使用Z形整形術來增加下嘴唇的高度，保持阻滯口水的能力。分別於術後11個月和37個月的追蹤中，記錄到張嘴的幅度大為增加，而且沒有漏口水的現象或是組織攣縮，並且組織捐供區無明顯的併發症。結論：對於嘴角因以往腫瘤切除手術造成牙關緊閉和疤痕攣縮，在釋放攣縮組織手術後產生中等大小的缺陷，以結合鼻唇溝皮瓣和Z形整形術是一種有效且相對簡單的重建方法。

並列摘要

Background: The lips and perioral structure play important functional and aesthetic roles for the face, and their reconstruction usually poses special challenges. Many procedures have been proposed to cope with trismus problem associated with peri-commissural contracture in the past. Nevertheless, local flaps are sometimes not sufficient to cover defects of the lip and perioral tissue. Free tissue transfers provide abundant soft tissue, but they entail time-consuming procedures and have a risk of complete flap failure. Aim and Objectives: Herein we present an alternative approach to address this difficult clinical problem and review the literature. Materials and Methods: Two patients presented with trismus and scar contracture of the oral commissure resulting from previous surgical excision of neoplasm and thereby received combined nasolabial flap and Z-plasty for trismus release and mouth angle reconstruction. Results: After releasing the contracture, a nasolabial flap was harvested and transposed for reconstruction of mouth angle and buccal mucosa defects. Meanwhile, a Z-plasty was designed to increase the height of the lower lip and deepen the inferior buccal gingival sulcus with an aim to restore the competence of the lower lip. Mouth opening substantially improved after the surgical interventions. No drooling or recurrence of scar contracture was noted, and donor site morbidity was inconspicuous at both the 11-month and 37-month follow-ups. Conclusion: Therefore, combined nasolabial flap and Z-plasty is an effective and feasible method for the reconstruction of the perioral defect after trimus and scar contracture release.

並列關鍵字

nasolabial flap ； Z-plasty ； trismus