Tongue flap transfer palate reconstruction

Transplantation of the lingual flap for the surgical treatment of sputum cancer. Most of the squamous cell carcinomas are squamous cell carcinomas, and the adenocarcinomas are from small salivary glands, which are less common in hard sputum than soft sputum, but the latter is highly malignant. Carcinoma often invades the epiphysis, causing the upper eyelid to communicate with the nasal cavity. According to the principle of tumor surgery, those who have invaded the periosteum must also remove the epiphysis. Defects in sputum will affect language and swallowing, affecting patients' lives and socialization, and may cause physical and psychological obstacles. In the past, it was advocated that the tumor could be repaired after the tumor was cured, because premature repair would affect the observation of tumor recurrence. Recently, many scholars advocate early repair, because timely recovery of function is conducive to the improvement of patient quality of life, and the endoscopic examination of fiber can completely achieve the purpose of monitoring tumor recurrence after surgery. The hard palate defect can be repaired with a local tissue flap, a regional pedicle flap or a free flap; the soft palate is rich in muscle, and currently only the repair of the tissue defect volume can be achieved, and there is no ideal means for functional repair. Treating diseases: soft sputum cancer Indication Tongue flap transfer reconstruction is applicable to: 1. One side or middle part of the iliac crest is resected but the width of the defect does not exceed 2.5 cm, especially if the aorta is damaged. 2. The anterior hole penetration defect is caused by the distal necrosis after bilateral cleft palate. Contraindications 1. Abnormalities of the tongue and back such as the tip of the tongue, leukoplakia of the tongue, hemangioma of the tongue, tongue of the map, cracked tongue or tongue have been defective. 2. Children, debilitated frail elderly or mentally abnormal can not cooperate. Preoperative preparation 1. The patient's mental preparation is due to the repair of the tongue flap. It is a pedicle repair. It is necessary to limit the activity of the tongue after surgery. It is difficult to speak and eat. It must be kept quiet for 3 weeks after surgery. 2. Prepare the head bandage before surgery so as to limit the mouth opening after the operation, prevent the tongue from being pulled and affect the wound healing. 3. Measure the defect and design the flap area and pedicle position according to the need of transfer repair. Surgical procedure Incision First, the perforation edge incision is made, that is, an arc-shaped incision is designed on both sides of the crucible, and the free edges of the two petals are relatively sutured, and the mucosa faces the nasal cavity, and the wound surface faces the oral cavity. The flap incision is designed according to the total area of the upper jaw and a "U" shaped incision at the tip of the tongue. The length to width ratio is generally 3:1. 2. Flap Firstly, the mucosal flap of the defect edge is cut, turned over, sutured in the midline, and the wound is oriented toward the oral cavity; then the surrounding mucosa is separated as a bone surface to receive the flap, which is convenient for suturing, and then the tongue mucosa and the submucosa are cut. The tongue mucosal flap is turned up along the surface of the muscle layer to prepare for repairing the defect. 3. Tongue transfer suture Firstly, the wound edge of the tongue donor area is sutured relatively, that is, the back of the tongue is closed. Then, the tip of the flap is lifted, and the wound surface is opposite to the upper jaw surface. The edge of the flap is sutured with the periosteum of the upper jaw by suture stitching. For the convenience of operation, the needle can be sutured first and finally knotted together. The suture was sutured with the 4th line in front of the tongue, and the long line was left and ligated to the front molars on both sides of the upper jaw. Finally, the head bandage is strengthened and fixed. In case of a big mouth. 4. Broken pedicure trimming Three weeks after the operation, the pedicle of the tongue was cut, and the excess tongue mucosa was repaired and sutured. complication 1. The front end of the tongue or all necrosis The main reason is the design error, the ratio of length to width is more than 3:1, or the pedicle is sutured too tightly, so that the tongue is bloody. 2. Infection Insufficient disinfection, infection in the mouth, intraoperative contamination. 3. The tongue is falling off The main reason is the poor postoperative tongue flap, frequent tongue movement or excessive opening of the lower jaw, which makes the tongue flap

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