The application of submental flap in the nasopharyngectomy for nasopharyngeal carcinoma
-
摘要: 目的 探索颏下瓣在鼻咽癌手术修复中的解剖要点和手术方法。方法 在5例新鲜冰冻头颅标本上进行颏下瓣的解剖学研究，重点探索颏下瓣转位至鼻颅底区的通道，分析颏下瓣所能覆盖的颅底区域。对4例复发性鼻咽恶性肿瘤患者行鼻咽癌扩大切除术并采用颏下瓣行鼻咽颅底修复。结果 解剖显示，颏下瓣经过下颌角后内侧-翼内肌后方-咽旁间隙通道可转位入鼻咽颅底，最远端可覆盖至斜坡旁段颈内动脉。临床实践显示，4例患者成功采用颏下瓣修复鼻咽颅底，随访见颏下瓣生长良好。结论 颏下瓣适用于鼻咽癌手术后的鼻咽颅底修复，值得临床推广。Abstract: Objective To explore the anatomy and clinical application of submental flap in the nasopharyngectomy for nasopharyngeal carcinoma.Methods The anatomical study of the submental flap was carried out on 5 cadavers, focusing on exploring the channel of the submental flap transposition to the nasopharyngeal skull base area, and analyzing the nasopharyngeal skull base area covered by the submental flap. A retrospective analysis of 4 patients with submental flap repairment after nasopharyngectomy was performed, and the surgical methods and techniques of submental flap to repair nasopharyngeal nasal skull base defect were introduced in detail.Rusults It showed that the submental flap could be transposed into the nasopharyngeal skull base through the posteromedial of the mandible-posterior pterygoid muscle-parapharyngeal space channel, and could cover the paraclival internal carotid artery. Clinical practice showed that the submental flap was successfully used to repair the nasopharyngeal skull base defect in 4 patients, and the submental flap grew well in the follow-up.Conclusion The submental flap is suitable for the repair of the nasopharyngeal skull base defect after nasopharyngeal carcinoma surgery, and it is worthy of clinical promotion.
-
-
表 1 4例患者的一般资料
例序 性别 年龄/岁 放疗时间/月 分期 病理诊断 1 女 59 18 T4N0M0 鼻咽部腺样囊性癌 2 女 42 36 T4N0M0 鼻咽部非角化性癌，未分化型 3 男 50 48 - 鼻咽癌放射性骨坏死 4 女 51 9 T3N0M0 鼻咽部透明细胞癌 
下载: 导出CSV
-
[1] 刘全, 孙希才, 于华鹏, 等. 鼻内镜下鼻咽癌切除术的手术分型[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 39-45. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYU201902008.htm
[2] Liu Q, Sun X, Li H, et al. Types of Transnasal Endoscopic Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma: Shanghai EENT Hospital Experience[J]. Front Oncol, 2020, 10: 555862.
[3] 刘全, 孙希才, 王欢, 等. 颞肌瓣鼻颅底区转位的解剖[J]. 解剖学报, 2020, 51(5): 659-663. https://www.cnki.com.cn/Article/CJFDTOTAL-JPXB202005006.htm
[4] 房居高, 王茹, 张嘉敏, 等. 经颌下咽旁间隙进路联合鼻内镜切除累及咽旁间隙鼻咽癌的初步探索[J]. 中国耳鼻咽喉头颈外科, 2021, 28(4): 215-217. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT202104006.htm
[5] Zhou WN, Wan LZ, Zhang P, et al. Anatomical Study and Clinical Application of Facial Artery Perforator Flaps in Intraoral Reconstruction: Focusing on Venous System[J]. J Oral Maxillofac Surg, 2017, 75(3): 649. e1-649. e10. doi: 10.1016/j.joms.2016.11.018
[6] 文军慧, 刑新, 卢范, 等. 颏下动脉带蒂皮瓣的临床应用解剖[J]. 解剖学杂志, 2002, 25(1): 68-70. https://www.cnki.com.cn/Article/CJFDTOTAL-JPXZ200201017.htm
[7] 高银光, 范飞, 尤建军, 等. 颏下皮瓣的应用解剖学研究[J]. 中国临床解剖学杂志, 2006, 24(1): 54-56. doi: 10.3969/j.issn.1001-165X.2006.01.014
[8] Mooney SM, Sukato DC, Azoulay O, et al. Systematic review of submental artery island flap versus free flap in head and neck reconstruction[J]. Am J Otolaryngol, 2021, 42(6): 103142. doi: 10.1016/j.amjoto.2021.103142
[9] Paydarfar JA, Kahng PW, Polacco MA, et al. The submental island flap in head and neck reconstruction: A 10-year experience examining application, oncologic safety, and role of comorbidity[J]. Laryngoscope Investig Otolaryngol, 2022, 7(2): 361-368. doi: 10.1002/lio2.741
[10] Shi K, Liu C, Peng W. Reconstruction of lower and midfacial soft tissue defects with a submental island flap[J]. J Plast Reconstr Aesthet Surg, 2022.
[11] Silva AK, Chang DW. Discussion: Twenty-Five Years of Experience with the Submental Flap in Facial Reconstruction: Evolution and Technical Refinements following 311 Cases in Europe and Africa[J]. Plast Reconstr Surg, 2019, 143(6): 1759-1760. doi: 10.1097/PRS.0000000000005679
-
图(5)
表(1)
计量
- 文章访问数: 1279
- PDF下载数: 247
- 施引文献: 0