下颌骨前部、口底和唇部复合缺损的挽救性重建

F. A. Khalid, Omar A Ahmed, Almeotan P Khurshid, A. Mujahid, Junaid Ahmad, Muhammad Saleem, M. A. Yousaf, M. Tarar, Farooq Shahzad
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摘要

下颌骨前部缺损会导致舌头、口底和下唇失去支撑,从而影响呼吸道、进食和言语。我们治疗了 4 名患有这种 "安迪-阿甘 "畸形的患者。我们用两个游离皮瓣进行了重建:一个是下颌骨前部和口底的腓骨骨皮皮瓣,另一个是嘴唇、下巴和颈前部的软组织游离皮瓣。下唇用筋膜或肌腱移植+/-迷你颞翻转皮瓣悬吊于颅内。所有皮瓣均完全存活。所有患者在手术前都依赖管饲;他们都恢复了口服饮食。所有气管造口均已拆除。唇部功能得到恢复,表现为不再流口水。语言表达能力也得到了改善,从无法理解到可以理解,并能经常重复。口内功能性格拉斯哥量表(FIGS)进行了客观评估;FIGS的平均得分从3.25分(范围3-4)提高到11分(范围9-13)。我们的结论是,复合下颌骨前部和舌头缺损需要大量组织,需要多个游离皮瓣。重建可显著改善功能。
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Salvage reconstruction of composite defects of the anterior mandible, floor of mouth and lip
Anterior mandible defects result in loss of support for the tongue, floor of the mouth and lower lip, resulting in impairment of airway, feeding and speech. We treated 4 patients with these ”Andy Gump” deformities. Reconstruction was performed with two free flaps: a fibula osteocutaneous flap for the anterior mandible and floor of the mouth, and a soft tissue free flap for the lip, chin, and anterior neck. The lower lip was suspended cranially with fascia or tendon grafts +/- mini-temporalis turndown flaps. All flaps survived completely. All patients were tube feed dependent before surgery; they all resumed an oral diet. All tracheostomies were decannulated. Lip competence was restored as evidenced by cessation of drooling. Speech improved from unintelligible to intelligible with frequent repetitions. Objectively assessment was performed with the functional intraoral Glasgow scale (FIGS); the mean FIGS score improved from 3.25 (range 3 to 4) to 11 (range 9 to 13). We conclude that composite anterior mandible and tongue defects have large tissue requirements that require multiple free flaps. Reconstruction leads to significant improvement in function.
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