组织瓣在口腔上颌窦瘘修复中应用.docVIP

组织瓣在口腔上颌窦瘘修复中应用[摘要] 目的：评价不同组织瓣在口腔上颌窦瘘修复中的应用。方法：收集2000年3月～2007年6月，在我院就诊的口腔上颌窦瘘患者26例，分别采用带蒂颊脂垫瓣、颊侧黏骨膜瓣、腭黏骨膜瓣修复转移修复。结果：7例采用带蒂颊脂垫瓣修复者均Ⅰ期愈合，采用颊侧黏骨膜瓣、腭黏骨膜瓣修复者各有1例失败，Ⅱ期采用带蒂颊脂垫瓣修复均正常愈合。术后随访3个月～2年，全部患者创口愈合良好，颊侧黏骨膜瓣修补的患者术后口腔前庭沟均有不同程度变浅，采用带蒂颊脂垫瓣修复者无供区功能障碍和面部畸形。结论：颊侧黏骨膜瓣、腭黏骨膜瓣能良好地封闭瘘孔较小的口腔上颌窦瘘，对于瘘孔较大、颊侧黏骨膜瓣或腭黏骨膜瓣无法完全封闭瘘孔者或术后需行活动义齿修复者，需采用带蒂颊脂垫瓣转移修复。 [关键词] 组织瓣；口腔上颌窦瘘；修复 [中图分类号] R782.2+4[文献标识码]C [文章编号]1673-7210（2009）05（b）-057－０2 The application of tissue flap in the reconstruction of oroantral fistula ZHU Lanxing (Department of Stomatology, the 2nd Affiliated Hospital of Henan College of Traditional Chinese Medicine, Zhengzhou 450002,China) [Abstract] Objective: To evaluate the clinical effect of the tissue flap in the reconstruction of oroantral fistula. Methods: From March 2000 to June 2007,26 cases with oroantral fistula were treated with buccal fat pad flap, cheek flap and palatal mucoperiosteal flap. Results: 7 cases with buccal fat pad flap achieved healing by first intention. 2 cases with cheek flap and palatal mucoperiosteal flap failed, and healed well when the buccal fat pad flap was adopted at the second stage. All cases were followed up 3 months to 2 years, the buccal vestibule of the tooth for patients with cheek flap were shallow in varying degrees. There were no obvious dysfunction and facial deformity for patients with buccal fat pad flap. Conclusion: The cheek flap and palatal mucoperiosteal flap can well seal the small oroantral fistula, while the buccal fat pad flap is useful in reconstruction of the big oroantral fistula. [Key words] Tissue flap; Oroantral Fistula; Repair 口腔上颌窦瘘常发生于上颌磨牙拔除术、上颌骨囊肿手术、上颌窦根治术以及上颌骨肿瘤切除术后，大的瘘孔常需用临近组织瓣转移修复以关闭创口。2000年3月～2007年6月，笔者应用带蒂颊脂垫瓣、颊侧黏骨膜瓣、腭黏骨膜瓣修复各种原因致口腔上颌窦瘘患者26例，术后取得较好效果，现总结报道如下： 1资料与方法 1.1一般资料 本组男15例，女11例。年龄22～63岁，平均38.5岁。穿孔原因：上颌磨牙拔除后穿孔17例，上颌骨囊肿术后穿孔6例， 上颌窦癌术后穿孔3例；缺损范围：7 mm×2 mm～37 mm×42 mm。其中5例因上颌窦炎同时实施口腔上颌窦瘘修补术与上颌窦根治术。 1.2治疗方法 颊侧滑行瓣修补术10例，瘘孔小于10 mm×5 mm，均因拔除上颌磨牙所致穿孔；腭黏骨膜旋转瓣修补术9例，瘘孔小于20 mm×