Reconstruction of Maxillary Defect by Temporalis Flap after Partial Maxillectomy-A Case Report

藉由顳肌皮瓣重建部分上頷骨切除手術之術後缺損－病例報告

Wei-Ting Chen(陳威廷)；Fei-Fan Tseng(曾非凡)；Yuan-Wu Chen(陳元武)

Partial maxillectomy ； Reconstruction ； Temporalis flap ； 部分上頜骨切除手術 ； 重建 ； 顳肌皮瓣

臺灣口腔顎面外科學會雜誌

35卷3期（2024 / 09 / 01）

230 - 241

英文;繁體中文

Reconstruction of maxillary defects is an important concern for oral and maxillofacial surgeons. These defects are commonly observed after the excision of malignant and aggressive benign lesions of the upper jaw, which can result in oral cavity dysfunction, such as dysphagia and dysphonia. Depending on the defect site and size, several local and regional flaps, which have shorter recovery times and higher success rates than free flaps, can be used in reconstruction surgery. Herein, we present the case of a 53-year-old native Taiwanese man diagnosed with a second primary squamous cell carcinoma (SCC) over the right posterior hard palate, pT3N0M0 stage III. The lesion was approximately 2.2 cm x 1.3 cm x 2.4 cm in size on magnetic resonance imaging, and whole body positron emission tomography-computerized tomography indicated cortical bone erosion of the maxilla. Partial maxillectomy with wide excision was performed, and the surgical defect was reconstructed using a right-sided temporalis flap through the zygomatic arch tunnel with blood supply of the deep temporal artery. The entire surgical procedure was uneventful, and the patient's postoperative condition was stable. The treatment outcome was satisfactory at the 6-month follow-up. Therefore, the temporal flap can be used to reconstruct maxillary defects. This case provides some clinical experience with the use of a temporalis flap for the treatment of patients with hard palate SCC.

上頜骨缺損的重建對於口腔顎面外科醫師而言是一個重要的議題，常見於惡性病灶或是高度侵襲性之良性病灶術後病人，這一類的缺損容易造成口腔功能的問題，如吞嚥困難或發音困難，而依據缺損的大小及位置，我們可以利用許多的局部及區域皮瓣來完成重建手術，對比游離皮瓣有更高的成功率及較短的術後恢復時間。在此呈現的病例報告為一位53歲台灣男性，被診斷為右後側硬顎續發性鱗狀上皮細胞癌第三期，在核磁共振檢查上顯示的病灶大小為2.2x1.3x2.4公分，並且在全身正子電腦斷層檢查上發現有上頜骨的皮質骨侵蝕，因此我們進行了廣泛性腫瘤切除手術合併局部上頜骨切除手術，並使用右側顳肌皮瓣通過顴骨弓外側來重建，皮瓣的血液供應為深顳動脈，整體手術過程十分順利，患者也有良好的術後復原狀況，且在六個月的術後追蹤後有穩定的治療成果。整體而言，在重建上頜骨缺損時，顳肌皮瓣可以作為選擇，本病例報告提供了使用顳肌皮瓣來治療硬顎口腔癌患者之相關臨床經驗。