Fundamental And Clinical Study On Preferred Reconstruction Method Of The Oral And Maxillofacial Soft Tissue Defects With Flap

Extensive soft tissue defect of oral and maxillofacial is an often and devastating event affecting patient life quality and adapt to society. It is necessary to restore oral and maxillofacial structure and function. So it is an important task for reconstruction surgery, reconstruction on oral and maxillofacial area is difficult because the facial structure is special and complicated founction. The technique had become cost efficient by using hemogeneous tissue flaps, and the technique had become the most efficient by using vascularized flap. What method should be adopted still present a considerable challenge to the surgeon. It can be found that the reconstruction method which surgeon chosen depends on their experience. There are no objective evaluation index for soft tissue struction and no efficient postoperative evaluation. So there are poor satisfaction with patients and surgeon.The aim of this study was to evaluate the defect quality of the oral and maxillofacial soft tissue (lip, cheek, tongue, floor of mouth, soft plate) of normal adults. The oral and maxillofacial soft tissue of 40 consecutive patients (20 man, 20 women) presenting withpleomorphic adenoma who had received general anaesthesia in west china college of stomatollogy were measured,the average age of 42.5 years (min. 20,max. 65).To provide data for morphologic,and to provide reference for reconstruction of the oral and maxillofacial soft tissue defects. 402 patients (282 man, 120 woman) who had reconstruction of soft tissue in west china college of stomatollogy during 1995.08-2004.10 were followed up, the average age of 51.5 years (min. 28, max. 75) .The different defects were classificated by different area and range. Clinical effects of reconstruction patient were evaluated. It can be found that Local flap is preferred flap for reconstruction of lip and cheek defects; tongue flap, nasolabial flap, palatal flap is preferred for middle cheek mucosa defects, free radial forearm flap is preferred for large anterior cheek mucosa defects, pectoral major myocutancous flap is preferred for large lateral cheek mucosa deep defects ; free radial forearm flap - pectoral major myocutancous flap, folded double-paddle pectoral major myocutancous flap is fit for cheek full defects; nasolabial flap, free radial forearm flap, plasysma flap was fit for middle defects of tongue or floor of mouth, pectoral major myocutancous flap was fit for large defects of tongue or floor of mouth; tongue flap, platal flap was fit for part defect of soft plate, free radial forearm flap-palatal flap was fit for full defect of soft plate.Based on these findings, morphologic data of adult oral and maxillofacial soft tissue is reference for reconstruction surgery. The selection of reconstruction method should depend on the rage of defect,site of defect and characteristic of flap. Generally, Local flap is preferred flap for reconstruction of lip and cheek defects; tongue flap, nasolabial flap, palatal flap is preferred for middle cheek mucosa defects, large defect was often filled with distant flap, free radial forearm flap is preferred for large anterior cheek mucosa defects, pectoral major myocutancous flap is preferred for large lateral cheek mucosa deep defects ; defect of tongue or floor of mouth was often reconstructed with distant flap , nasolabial flap, free radial forearm flap, plasysma flap was fit for middle defects of tongue or floor of mouth, pectoral major myocutancous flap was fit for large defects of tongue or floor of mouth; tongue flap, platal flap was fit for part defect of soft plate, free radial forearm flap-palatal flap was fit for full defect of soft plate.