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目的:钛板外露是肿瘤切除后应用钛板重建下颌骨最常见的并发症,本研究对应用延长下斜方肌肌皮瓣覆盖暴露的重建钛板的疗效进行评估。方法:选取中山大学孙逸仙纪念医院口腔颌面外科收治的12例口腔癌或口咽癌下颌骨部分切除术后重建钛板外露的病例,应用延长下斜方肌肌皮瓣修复暴露的重建钛板。原发肿瘤包括下牙龈或下颌骨鳞癌5例,颊黏膜癌3例,口底癌2例,舌根癌2例;下颌骨术后缺损包括半侧下颌骨缺损1例,正中缺损2例,侧方缺损9例;重建钛板暴露方式包括口内暴露1例,口外暴露7例,口内、口外暴露4例。8例口内或口外暴露钛板应用6 cm×7 cm~6 cm×23 cm大小的延长下斜方肌肌皮瓣覆盖,4例口内、口外均暴露的钛板应用折叠下斜方肌皮瓣覆盖。结果:所有患者皮瓣存活。随访12~36个月(平均22.8个月),1例(8.3%)患者在术后第20个月出现重建钛板外露。9例(75.0%)患者无病生存,2例患者带瘤生存,1例(8.3%)患者在第23个月因肿瘤转移而死亡。结论:延长下斜方肌肌皮瓣修复口内、口外或口内、外钛板外露是一种可靠的方法。
OBJECTIVE: Titanium plate exposure is the most common complication of mandibular reconstruction with titanium plate after resection of the tumor. This study evaluated the efficacy of extended exposure to the reconstructed titanium plate with the lower trapezius muscle myocutaneous flap. Methods: 12 cases of oral cancer or oral or maxillofacial carcinoma underwent partial reconstruction of mandibular part of Sun Yat-sen Memorial Hospital of Sun Yat-sen Memorial Hospital were enrolled. Reconstructed cases of titanium plate were treated with extended myocutaneous myocutaneous flap to repair exposed titanium plate . Primary tumors included 5 cases of inferior gingiva or squamous cell carcinoma of the jaw, 3 cases of buccal mucosal carcinoma, 2 cases of floor-mouth carcinoma and 2 cases of tongue-root carcinoma. The mandibular defects included 1 case of half mandibular defect, 2 cases of median defect, Lateral defects in 9 cases; reconstruction of titanium plate exposure methods including 1 case of oral exposure, 7 cases of oral exposure, oral and oral exposure in 4 cases. Eight cases of titanium plate exposed in the mouth or outside the mouth were covered with an extended lower trapezius myocutaneous flap with a size of 6 cm × 7 cm ~ 6 cm × 23 cm. Four cases of titanium plate exposed in the mouth and outside of the mouth were treated with folded lower trapezius flap cover. Results: All patients with flaps survived. During the follow-up of 12 to 36 months (average 22.8 months), one patient (8.3%) showed titanium exposure at 20 months after operation. Nine patients (75.0%) had disease-free survival, two patients survived with tumor, and one patient (8.3%) died of tumor metastasis at 23 months. Conclusion: Extending the lower trapezius muscle myocutaneous flap to repair the mouth, mouth or mouth, outside the exposed titanium plate is a reliable method.