Application Of Palatal Mucoperiosteal Island Flap For Reconstruction Of Defects For Nasopharynx

Objective:Through dissect anatomical study of palatal mucoperiosteal and nasopharynx to discuss thefeasibility of palatal mucoperiosteal island flap for reconstruction of defects for nasopharynx,and provide data for clinical application.Materials and methods:1.10cases of adult head and neck specimens fixed with10%formalin.10cases right.10casesleft.4cases of fresh adulthood head and neck specimens.4cases right.4cases left.2. Generally dissect head and neck specimens. Maxillary artery is revealed. Observe the runni-ng of maxillary artery, and trace the branch of maxillary artery like descending palatineartery and greater palatine artery. Greater palatine nerve accompanying with artery isrevealed. Measure the length of descending palatine artery （L₁）from the beginning to greaterpalatine artery.3. Fix six points in hard palate. Measure the thickness of mucoperiosteal of hard palate in eachfixed point. Measure respectively the length of sutura palatina mediana （AC） and the halflength of rearend hard palate （AB）. And then generally dissect hard palat, revealed greaterpalatine foramen, observe the running of greater palatine artery, trace the branch of greaterpalatine artery. Measure separately: the external diameter of greater palatine artery at greaterpalatine foramen R1, the length of greater palatine artery in palatine bones L2, the length ofgreater palatine artery from the first branch of greater palatine artery to greater palatineforamen （L₃）, the length of greater palatine artery from the last branch of greater palatineartery to greater palatine foramen （L₄）, the dimension of hard palate （S₁）. mid-plane betweenit and4. Expose nasopharynx, choose the horizontalplane of nasopharynx roof as the upper bound, the horizontalplane of the first cervical vertebra as mid-upper bound, themid-horizontalplane of the first cervical vertebra as the mid-low bound, the plane of softpalate as the low bound, and divide the nasopharynx into three sections——the upper part ofnasopharynx, the middle part of nasopharynx, the lower part of nasopharynx. Measureseparately: the vertical distance of the three parts, the width of the three parts, the dimensionof the three parts.5. Debond palatal mucoperiosteal island flaps with vascular pedicles. Measure separately:the farthest distance from greater palatine foramen to nasopharynx roof （L₅）,the farthestdistance from greater palatine foramen to nasopharynx side wall （L₆）, the available length ofhard-palate flaps with vascular pedicles （L₇）, the farthest distance of hard-palate flaps withvascular pedicles can cover （L₈）, rotating angle of transferring palatal mucoperiosteal islandflaps to nasopharynx （An）.Results:1. the thickness and length of palatal mucoperiosteal:the thickness of palatal mucoperiosteal A2.40±0.91mm; C4.31±1.36mm;D1.47±0.49mm; B left3.16±1.28mm, right3.24±1.25mm; E left5.33±1.47mm,right5.33±1.23mm; F left7.95±1.61mm,right8.08±1.76mm;the length of sutura palatina mediana（AC）47.31±9.24mm; the half length of rearend hardpalate （AB） left24.91±3.28mm, right24.93±3.69mm.2. the relative length and external diameter of greater palatine artery:The length of descending palatine artery L1left32.81±8.07mm, right32.80±7.35mm;the relative length and of greater palatine artery L₂left6.67±0.77mm,right6.77±0.61mm; L3left7.23±2.11mm, right8.22±2.93mm;L4left39.78±4.74mm, right40.26±5.86mm;the relative external diameter of greater palatine artery R₁left1.04±0.12mm,right1.02±0.09mm.3. the available dimension of hemi-palatal mucoperiosteal:S1left601.81±194.87mm2, right603.61±203.84mm2.4. the length and width of the three parts of nasopharynx: L96.46±0.90mm,W₁33.00±3.71mm, L₁₀8.53±0.87mm,W₂37.06±6.43mm,L₁₁10.53±0.85mm,W₃30.48±3.77mm.5. the dimension of the three parts of nasopharynx:S2234.67±87.38mm², S3289.70±94.28mm², S4323.08±60.04mm².6. the relative length of palatal mucoperiosteal island flap:the farthest distance from greater palatine foramen to nasopharynx L5left39.95±5.57mm,right40.80±5.34mm; L₆left39.39±4.52mm, right40.16±4.57mm;the relative length of debond palatal mucoperiosteal island flaps L7left13.90±2.25mm,right15.14±2.79mm; L8left46.44±4.49mm, right47.18±5.81mm.7. the rotating angle of transferring palatal mucoperiosteal island flaps to nasopharynx:An left57.41±7.73°, right58.20±7.88°.Conclusion:Palatal mucoperiosteal island flaps can remove to nasopharynx and reconstruction everyparts tissue defects of Nasopharynx.