岛状颊肌粘膜瓣修复腭痿临床探究［摘要］目的：探索应用岛状颊肌粘膜瓣方法修复较大面积腭痿的临床实践，探讨该方法的优缺点。方法：应用蒂在前上的岛状颊肌粘膜瓣修复腭痿4例；应用蒂在后的岛状颊肌粘膜瓣修复腭痿14例，其中有7例在修复腭痿的同时延长软腭以矫正腭咽闭合不全。结果：共修复腭痿患者18例；其中15例腭部痿孔获得关闭，颊肌黏膜瓣成活良好，无感染、腮腺导管损伤或阻塞、面神经损伤，无张口受限、瘢痕挛缩及咀嚼障碍；2例因岛状颊肌粘膜瓣远端愈合不良再次出现硬腭前端痿口，但面积较原来明显减小，其中1例再发腭痿应用已转移到腭部的颊肌粘膜瓣组织行二次手术修复后愈合；1例岛状颊肌粘膜瓣部分坏死。结论：应用蒂在前上和蒂在后的岛状颊肌粘膜瓣修复腭痿是一种比较安全可靠的方法，其成活率高，可以灵活转移修复各个部位的腭痿,在修复软硬腭交界部位腭痿的同时可延长软腭、矫正腭咽闭合不全。即使腭痿再发，可以应用已转移到腭部的肌黏膜瓣修复之。［关键词］腭痿；岛状颊肌粘膜瓣；腭裂［中图分类号1R782.05［文献标识码］A［文章编号11008-6455(2009)03-0302-05AclinicalstudyontheBuccinatorMusculomucosalIslandFlapforPalatalFistulaRepairMATing-ting,ZHAOZhen-min,YINNing-bei,XIONGBin,CHENGTing,WANGChun-yan,WUDi,YANWei,TANGXin,QINYong-ping(TheFirstDepartmentofPlasticSurgeryHospital,ChineseAcademicMedicalScieneeandPekingUnionMedicalCollege,Beijing100144,China)Abstract：ObjectiveToexploreandevaluateclinicalapplicationsofbuccinatormusculomucosalislandflapforpalatalfistularepair・MethodsThebuccinatormusculomucosalislandflapspedicledsuperior-anteriorlybasedonthedistaiportionofthefacialarterythroughtheanteriorbuccalbranchesandpedicledposteriorlybasedonthebuccalarteryandposteriorbranchesofthefacialarteryweredesignedforpalataifistularepair・18palataifistulaewererepairedbythismethod,4pedicledsuperior-anteriorlyand14pedicledposteriorly,7ofwhichgotvelopharyngealincompetencecorrectionatthesametime.ResultsAllofthepatientsgotsatisfactoryfistulaclosureexcept3complications.Oneflapgotpartlynecrosisandtwogotfistulaeatthehardpalate・However,thefistulasizeswerereducedgrea.tlyandonehasbeenre-repairedwellbythetransferredbuccinatormusculomucosalflaponeyearlater.Allthepatientshadnofacialnervesinjuries,nolimitationinmouthopeningandnomasticationdifficulty・ConelusionThebuccinatormusculomucosalislandflapspedicledsuperior-anteriorlyandposteriorlyaretrustworthyandsafeforpalatalfistularepair・Itcanbetransferredconvenientlytorepairfistulaofanyposition.Theflappedicledposteriorlycanprolongthesoftpalatemeantime,whichishelpfultosomefistulapatientscomplicatedbyvelopharyngealinsufficiency.Evenifafistularecurred,thetransferredbuccinatormusculomucosalflapscouldprovideenoughtissueforanothersurgeryrepair.Keywords：buccinatormusculomucosalislandflap；palatalfistula；cleftpalate腭痿是腭裂术后最常见的并发症。腭裂术后伤口愈合过程受裂隙的大小、手术操作的熟练程度、以及患者术后的吞咽、咳嗽等各种因素的影响。感染、血运欠佳、张力过大易造成伤口愈合不良、糜烂、裂开及穿孔。早期报道腭痿发生率均在20%[1]以上，通过采取各种方式的预防，腭痿的发生率逐渐下降，报道为4%〜10%[2-7],仍不能完全避免。由于其对发音、饮食、生长发育的影响，大部分腭痿应在腭裂术后半年之后，结合自身的状况进行手术修复。腭痿常发生在硬腭前端和软硬腭交界处。粘骨膜瓣后退腭血管神经束张力使腭粘骨膜瓣无法完全覆盖硬腭前端的裂隙，容易出现硬腭前端的痿孔；软硬腭交界处组织菲薄,裂缘肌层薄弱，腭盖高拱，术后易裂开；腭粘骨膜瓣的血运受到影响，则可能坏死出现大面积的痿孔。这些类型的痿孔周围瘢痕明显，可动员的组织不多，再次修复难度较高，术后腭痿复发...