摘要
目的探讨腮腺深叶癌根治手术切除后,面部凹陷畸形及面神经缺损进行功能性修复的新方法,并评价临床疗效。方法对12例腮腺深叶癌侵袭周围骨质的患者,采取开放面神经管,将癌瘤、腮腺、受累面神经及周围骨质(包括乳突、茎乳孔、茎突及下颌升支后缘)扩大切除,利用面神经管内段正常的神经干断端与胸锁乳突肌肌瓣相连的耳大神经进行吻合,同时利用胸锁乳突肌肌瓣填充凹陷畸形。结果开放面神经管利用耳大神经胸锁乳突肌肌瓣功能性修复的方法,9例腮腺区凹陷畸形明显恢复常态,2例因肿瘤复发再次手术切除留有明显凹陷畸形,1例因局部感染,组织液化,肌肉萎缩,出现凹陷。面神经功能完全恢复,恢复时间最短为12周,最长20周,平均163周。同时提高了肿瘤的局部控制率。结论开放面神经管腮腺癌根治术,用耳大神经-胸锁乳突肌肌瓣即时修复,既达到了面部凹陷畸形的整复,又实现了面神经的功能性修复,同时减少肿瘤的局部复发,符合功能外科修复的发展要求,是一种临床应用效果比较理想的方法。
Objective\ To study a new method for repair of facial depression and facial nerve defect after parotid carcinoma reseciton. Methods\ 12 patients with parotid carcinoma and peripheral bone invasion were treated using facial nerve canal dissection and radical resection of the tumor,the parotid gland and the involved facial nerve and bone,including the mastoid,stylomastoid foramen,styloid process and the rear part of the mandible.A sternocleidomastoid muscle flap was elevated and transferred to repair the facial depression.The great auricular nerve in the flap was anastomosed with the severed end of the facial nerve in the canal. Results\ The depressed deformity of the parotid area was well corrected in 9 patients.The aesthetic results were compromised in 2 patients because of tumor recurrence and reoperation.The depressed deformity was not corrected in 1 patient because of infection.Postoperatively,the function of the facial nerve recovered to a normal level.The recovery time ranged from 12 to 20 weeks,with an average of 16 3 weeks.The local control rate of tumor was improved. Conclusions\ Immediate transplantation of the sternocleidomastoid muscle\|great auricular nerve flap and facial nerve canal dissection in radical parotidectomy can repair the depressed deformity of the parotid area,restore facial nerve function,and decrease tumor recurrence.The method is an ideal operation with functional recovery.\;
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2004年第6期425-427,共3页
Chinese Journal of Plastic Surgery
