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目的:探讨上颌骨大块组织切除后同期行上颌骨成形的可行性。方法:①重建上颌骨底壁:采用带蒂鼻中隔向下翻折与颊瓣相吻合;或利用残存的硬腭黏骨膜瓣与颊瓣相吻合;②重建上颌骨上壁:用带蒂鼻中隔向上翻折与眶下外侧缘固定;③重建上颌骨前壁:术中先带蒂翻揭上颌窦前壁骨片,术毕复回原位固定。结果:恶性肿瘤34例中,3年生存率为67.6%(23/34),5年生存率为35.3%(12/34)。良性肿瘤3例术后5-8年未见复发。重建上颌骨底壁29例, 术后吞咽、发声功能良好。重建上颌骨顶壁5例,术后患者眼球无下陷、无复视。重建上颌骨前壁3例术后面颊部无明显凹陷畸形,深呼吸时面颊皮肤无波动感。结论:上颌骨大块切除时同期行上颌骨成形术符合生理要求,延长了患者生命, 提高了生存质量。
OBJECTIVE: To investigate the feasibility of maxillary remodeling in the same period of maxillary excision. Methods: ① reconstruction of the bottom of the maxillary wall: the use of pedicle nasal septum fold down and cheek flap coincide; or use of residual hard palate mucoperiosteal flap and cheek flap match; ② reconstruction of the maxillary wall: with pedicle nasal septum upturned Fold and infraorbital lateral margin fixation; reconstruction of the anterior maxillary anterior wall: first pedicle pedicle open the anterior wall of the maxillary anterior bone slices, the operation is completed in situ fixed back. Results: Among the 34 cases of malignant tumors, the 3-year survival rate was 67.6% (23/34) and the 5-year survival rate was 35.3% (12/34). No recurrence was observed in 3 cases of benign tumor 5-8 years after operation. Reconstruction of 29 cases of the maxillary base wall, postoperative swallowing sound good. Reconstruction of the maxillary maxillary wall in 5 cases, postoperative patients with no subsidence of the eye, no diplopia. Reconstruction of the anterior maxilla 3 cases of postoperative cheek no significant depression deformity, deep breathing cheek skin no sense of fluctuation. Conclusion: Maxillofacial resection coincides with physiological requirements during the same period of maxillofacial surgery, prolonging the life of patients and improving the quality of life.