悪性腫瘍切除後の有茎皮弁による口腔の再建術と術後機能

RECONSTRUCTIVE SURGERY OF THE ORAL CAVITY FOLLOWING EXTIRPATION OF MALIGNANT TUMOR AND POSTOPERATIVE FUNCTIONAL EVALUATION

　I．はじめに

　悪性腫瘍切除後の口腔の広い欠損は上顎骨または，下顎骨切除による顔面の変形の他に，その部位に応じて種々の機能障害を起こす。頬部から口角部にかけての大きい欠損では開口障害，流涎，義歯の挿入困難が，頬部から軟口蓋にかけての大欠損では，開鼻声，構音障害，嚥下障害が，舌，舌根部，口腔底の広い欠損では，著明な構音障害，嚥下障害が，また無歯顎症例での硬口蓋の広い欠損では義歯の挿入，保持は困難となり咀嚼および嚥下障害，開鼻声が起こる。われわれはこれらの大きな形態および機能障害の予想される術後欠損を伴つた症例には，D-P皮弁（deltopectorial flap），前額皮弁，頸部皮弁，咽頭粘膜弁，遊離植皮などの皮弁，粘膜弁を用いて一次的に形態，機能の再建を計つており，ほぼ満足すべき結果を得ている。術式の選択は，欠損の部位と大きさ，年齢，性別，職業，その他のいくつかの要因により異なるが，口腔内の大きい術後欠損を伴つた症例を示し，用いられた術式と術後の形態機能について2〜3の考察を加えてみる。下顎，口腔底腫瘍切除後のD-P皮弁，頸部皮弁，遊離皮弁を用いた再建法については別報^7）で述べ，本報では触れない。

　Various surgical techniques in reconstruction of large defects that may result in the cheek, the oral angle, the oral floor, the tongue or the soft and hard palate after extirpation of malignant tumors in this region are described with their indications.

　The degree of postoperative restoration of deglutition, speech articulation, mastication and nasopharyngeal permeability are evaluated by means of cineradiography, phonetical and aerodynamic devices.

　The loss of more than a half of the soft palate may be reconstructed by means of employing a pharyngeal flap or by combination of pharyngeal and forehead flaps.

　In large defects encompassing more than three-fourths of the tongue and the oral floor, the reconstruction may be attained by covering the exposed muscles of the oral floor by means of flaps obtained elesewhere which will preserve the movement of the remaining portion of the tongue in fairly satisfactory amount.

　A large defect that may be left in the soft and hard palate after maxillectomy is reconstructed by use of D-P flap or the lined forehead flap.

　For the optimum functional restoration, selection should be made for the proper reconstructive technic in accordance to the size of the defect, dental conditions, age and sex and other individual conditions.