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Methods and studies of tongue reconstruction

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Methods and studies of tongue reconstruction

    Methods and studies of tongue

    reconstruction

    国际口腔医学杂志第34卷第520079

    .emafnlournal0fSfom8foy.34?o5Se2C

    综述

    Methodsandstudiesoftonguereconstruction

    ?339?

    FahmiA.Numan,LIAOGui-qing

    (Depc.0r?d舨?;Surgery,G"硼?Schoo

    ofStomotology,SunYat-SenUrdversity,Gttangzhou510055,c)

    [Abstract]Totalandevenpartialglossectomycouldbeamajoreventinthelifeofapatient.Tonguefunction

    issoc0mplicatedwhichmakesmaintainingnormalfunctionsofthetonguesuchasswallowingandspeechand

    preservinglarynxintegrityafterthesurgeryisaprimaryobjectiveofthesurgeon.Thistaskisverydifficultand

    theresuItisnotDredictable.Recentyears,however,therehasbeeninterestingdevelopmentsinmicrosurgieal

    techlliques.aJ1dtheseadvancementsenableoralandmaxillofaeialsurgeonstoachievebetterresultsandimprove

    thequalityoftheirpatient,slife.Theresultsevenwithuseofthenewtechnologyarestillfarfromperfect.Sev

    eralreas0nsmavcausev

    ati0nintheresult.Someofthemhavetodowiththepatientsuchasgeneralhealth and0therreas0nsaI.eduetothemethodthatisusedandnatureofthedefectaftertheremovalofthetumor.

    Thisanic1ewasundertakentosummarizetheval'iOUSmethodsandtechniquesusedoverthe

yearstorestoreoral

    tonguefunctionsafterdefects.

    Keywordstonguedefects;reconstruction;glosseetomy:freeflaps

    1Aimoftonguereconstruction

    Tonguecancerisarelativelyuncommoncancer inthegeneralpopulation,butcanresultinmajor disruptionsinpatientslife.Tonguenormalfunc

    tionswhicharespeechandswallowing,comprise twoofthemostimportantactivitieswehaveona dailybasis,andtongueistheprimarycomponentin both.Therestorationofspeechandswallowing functionistheprimarygoalwhenreconstructing tongueandsofttissueintheoralcavity. Anatomicalrehabilitationwasoncetheonly ofreconstructivesurgery,butnowitrepresentsonly onestepinthecompletefunctionalrecoverypro——

    cesstoallowresumptionofphysiologicalactivity. Softtissueandnervesplayimportantrolesin functionalrecovery.butthepotentialofthesestrue

    turesisnotyetwellknown.Rehabilitationafter oralcavityreconstructionbyfleeflapsneedsinter——

    disciplinarydiagnosticandtherapeuticapproaches, 【收稿日期】20070226;【修回日期】2007-05-21

    【作者简介】FahrniA.Numan(1978),,也门人,硕士

    【通讯作者】LIAOGui-qing,(廖贵清),Tel:020-83862531

    inwhichneurosensoryrecoveryoftransferredtis

    sueisanimportantaspect.

    2Methodsandtechniquesoftonguerecon'. struetion

    Varioustechniquesoffreeflapswereusedover

theyearstorestoreoraltonguefunctions,there

    quirementsofanidealfreeflapincludeprovision ofadequatemobilitywithpliability,adequateof bulkandprovisionofacompatibleepithelialor mucosaltissue.

    2.1Forearmfreeflap

    Microvascularforearmfreeflapstransplanthas beenknownf0rmorethantwentyyearst1.Forearm freeflapshavetheadvantageofbeingflexibleand thinnerIItisconsideredtheworkinghorseforre

    c0nstructionalmostalldefectsoforaleavityaSome authorsusedtheforearmfreeflapswithtwelve Datientswhosufferedfrommajordefectsafterthe removaloftonguetumors.Theyevaluatedtaste functionafterthetonguereconstruction.Even thoughtherewasnotasteperceptioninthetrans——

    plantedregionofthetongue,noneoftheirpatients showedtastedisorderproblems[31.Thismadethe

?3?

    researcherstoassumethattastefunctionwastaken placeinadifferentpartoftheoralcavity. Radial

    forearmfreeflapwasfoundtohaveasensorysu- perioritycomparedtonativeforearmflap.The sensoryfunetionoftheinnervatedradialforearm freeflapwasreportedtoapproachofthenormal tongueinallseventeenpatientswhounderwent reconstructionofglossectomydefectst41.Someau

    thorsevaluatedvariousfunctionssuchasspeech

    intelligibility,patientssurvival,freeflapsuccess andcomplicationsaftertheuseoffasciocutaneous flapsobtainedfromtheforearmoffortypatientst~3. Theresearchersusedvarioustechniquesdepending onthetypeandlocationofthedefecttoperform thereconstructionsurgery.Thetechniquesincluded longitudinal-foldmethodforthosewhohadminor defect,andfoldandroletechniquesforpatients wholostthreequartersoftheoraltongue. The

    patientswholosttheentireoraltongue.multidi

    mensionalfoldmethodswereapplied.Interestingly, itwassuggestednottoperformaflaptransplant afterpartialglossectomyifthespeechwasthe onlyoutcomeofinterest.Thissuggestionwasbased ontheresuhofastudyinvolved19patientswho underwenthemiglossectomyorminorglossectomy. TheresearcherfoundthatthearticulationresuIts ofthosewhodidnothavereconstructionworkweI.e bettert61.In1998,anarticlewaspublishedwhich arguedthatprimaryclosureofthedefectgave equalorbetterspeechandswallowingfunction comparedtoskinorskinmuscleflapreconstruc.

    tionm.

    Ingeneral,theshortcomingsoftheuseoffore

    armfreeflapsarepossibilitiesoflosingthearm, thedevelopmentofpathologicfracturesofthebone. andtheneedforskingraftingalwaysexists. Theuseofforearmwithothertypeofmuscles

couldbeanotherchoiceforsurgeons.Somere

    searchersusedacombinationofinfrahyoidmvo

    fascialflaps(IMF)witharadialforearmflaps(RFF) toreconstructamajordefectthataffectedhalfto twothirdsofthetongue.Forpatientswhoseentire oraltongueswereresected,theresearchersused bilateralinfrahyoidmyofascialflapscoveredbya 国际口腔医学杂志第34卷第520079

    alofStomato|ok,'vVo1.34No.5

    radialforearmflaps.Theresearchersarguedthat thesimplicityofreportedprocedurereducedthe timeneedforsurgeryandpostoperativerecovery. RFF,anteriorlateralthighflaps(ALTF),andfibu

    larosteocutaneousflap(FOCF)werereconstmctive

    8J.Restoringappropriatetonguefunctions options

    suchasfreefeeding,speechandswallowingwere achieved.

    2.2Buccinatormusculomucosalislandflap Buccinatormusculomucosalislandflapwasalso usedforpartialtonguereconstruction.Thistypeof flapswaspreferredduetoitscharacteristicsthat resemblethoseofthelingualtissuessuchasthin

    ness,capabilityofmucusproduction,highcellre

    newalrateandexcellentcolor.Theauthorsreported satisfactoryresultsofthesurgeriesinallsixteen patients[91.

    2.3Anterolateralthighflap

    Reinnervatedanterolateralthighflapwasreported tobeusedinthefunctionalreconstructionof mobiletongue.Thisapproachwasfoundtohave

    somesensorysuperioritycomparedtononinnervated anterolateralthighflap1o]_Inaddition.hairlessskin andeasinessofpositioningofthistypeofflaps madethismethodagoodchoicefortonguerecon.

    struction.Thedimcuhiesofdissectionandsmall variablepediclewereconsidereddisadvantageswith thismethod.

    AcomparisonbetweentheoutcomesofIlecon

    structionsurgeriestorepaircircumferentialpharyn

    gealdefectsusinganterolateralthigh(ALT)flap andjejunalflapwasreported.Thestudyinvolved 58patients.TwentysevenofthepatientshadALT flapandtheresthadjejunalflap.Thestudyshowed thattheoutcomesofAIJTflapwerebetterinterm ofbetterdonorsurvival,andshorterhospitaldura

    tion.Theeasinessoftailoringtheskinandthe muscleinthecaseofALTflapmadethistypeof flapsversatileinthereconstructionofheterogeneous softtissueofheadandneckdefects.Itwasalso reportedthatAIJTflaprequiredlittleornoreposi

    tioningandminimizedseriousdonormorbiditytu~. 2.4Abdominisflap

    Someresearchersreportedtheuseofrectus

国际口腔医学杂志第34卷第520079

    InternationalJournalofStomatolo~'vVo1.34No.5Seo.2007 abdominismusculocutaneousflapincombination withtenthintercostalsnerve.Thesurgeonsanato

    mizedtheabovementionednervetotheremaining

    hypoglossalnerve.Averyimportanttaskthatwas takenintoconsiderationduringthissurgerywas themovementsynchronizationofthetransplanted flapandtheremainingparttheoriginaltongue. Aftersixmonthsofthesurgery,thetonguewas foundtohaveagoodvolumeandtheswallowing functionimprovedveryconsiderably.Inanother publishedarticle,theresearchersarguedthatrein- nervatedrectusabdominismuscul0perit0nealflaps showedabetterresultcomparedtorectusabdo- minismyocutaneousflap.Thesuperiorityofthe muscul0perit0nealflapscamefromthefactthatit containedrectusmuscle,posteriorrectussheath, peritoneumandavascularpediclef.Inaddition tothis,muscul0perit0nealhadbettertissuecom

    pliance.Someresearcherssuggestedtheuseof rectusabdominismuscul0cutane0usflapsbecause theresearchersfoundastrongcorrelationbetween heightandwidthofthetransplantedflapsand postoperativefunctionf.Whenever.therewasa contactbetweenthehardpalateandtherecon——

    structtongueinthepatientsunderwentsubtotal glossectomy,therewasaremarkableimprovement inthespeechineligibilityandotherpostoperative function.Somedisadvantagesoftherectusabdo- minisfreeflapcouldcomefromthepossibilityof thedevelopmentofherniainthepatientandthe lackofsensationunlesstheflapwasreinnervated. Theeffectofvariousfactorsontonguemobility andarticulationwasstudied.Theresearchersfound

    thatthetypeofdefectwasthemostinfluential factorontonguemobilityfollowedbysizeofpost- excisionaldefect14.Thequalityoflifeof118pa- tientswhohadprimarysurgeriestoeradicatecan-

    ceroustissuesfollowedbyreconstructionofthe anteriortongueandsoftpalatewasihvestigated. Theresearchersfoundthatpatientswhohadthree ?34l?

    quartersortotalanteriorglossectomyshowedpoorer oraltonguefunctionssuchasswallowingandchew

    ingcomparedtothosewhohadequivalentsoft palateresection[5t.

    Asmentionedinthepreviousparagraphs,each techniquehasadvantagesanddisadvantagesand thepostoperativefunctionsvariesfromonepatient toanotherandfromonemethodtoanother.The effortshouldfocusondevelopingwaystoimprove postoperativefunctions,speedrecoveryandrecon

    structafullymobiletongue.

    3References

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    图分类号】R782.2【文献标识码】A

    (本文编辑骆筱秋)

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