Dynamic Oromandibular Reconstructions Using Chimeric Fibular and Gracilis or Vastus Lateralis Free Flaps

Min Wook Kim, J. Choi, W. Jeong, S. Nam, S. Choi
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引用次数: 1

Abstract

Abstract Background Despite efforts of head and neck functional reconstruction, anatomic restoration has been used until now. This article describes our experience of using a chimeric free fibular osteocutaneous flap conjoined with a functional muscle free flap, defined as dynamic oromandibular reconstruction. Methods Through a retrospective chart review, four consecutive patients who underwent reconstruction with a total fibular free flap were included. The former two patients underwent reconstruction using a conventional osteocutaneous free fibular flap. The latter two patients had an oromandibular defect after cancer resection and underwent dynamic oromandibular reconstruction with a chimeric free fibular flap conjoined with a gracilis free flap or vastus lateralis muscle free flap. Results In the speech analysis, the dynamic group revealed a satisfactory tongue movement. Protrusion and lateralization were the most different movement changes. The tongue range of motion score was 62.5 in the dynamic group and 25.0 in the control group. On the dynamic magnetic resonance imaging, the contact of the soft palate with the tongue was excellent, and the epiglottis closure during deglutition was complete. In the three-dimensional volumetric analysis of mandibular aesthetic contouring, the dynamic group showed a much smaller difference in hemifacial volume, with a difference of 73.7 mL in the dynamic group and 101.76 mL in the control group. Conclusion This study is a preliminary trial of dynamic oromandibular reconstruction using chimeric free fibular flaps with functional muscle transfer. We demonstrated the possibility of dynamic oromandibular reconstruction, which enhanced more functional aspects in the patients in this study.
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利用腓骨和股薄肌或血管外侧游离皮瓣动态重建下颌
摘要背景 尽管进行了头颈部功能重建的努力,但解剖修复一直被使用到现在。本文介绍了我们使用嵌合游离腓骨骨皮瓣与功能性无肌皮瓣相结合的经验,该皮瓣被定义为动态口下颌重建。方法 通过回顾性图表回顾,纳入了四名连续接受全腓骨游离皮瓣重建的患者。前两名患者采用传统的腓骨骨皮游离皮瓣进行重建。后两名患者在癌症切除术后出现口下颌缺损,并采用嵌合体游离腓骨瓣结合股薄肌游离瓣或股外侧肌游离瓣进行动态口下颌重建。后果 在言语分析中,动态组表现出令人满意的舌头运动。突出和偏侧是最不同的运动变化。动态组的舌头活动范围得分为62.5,对照组为25.0。在动态磁共振成像上,软腭与舌头的接触非常好,吞咽过程中会厌闭合完全。在下颌美学轮廓的三维体积分析中,动态组的半面部体积差异要小得多,差异为73.7 动态组为mL,101.76 对照组为mL。结论 本研究是利用嵌合游离腓骨皮瓣结合功能性肌肉转移进行动态口下颌重建的初步试验。我们证明了动态口颌重建的可能性,这在本研究中增强了患者的更多功能。
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14 weeks
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