上海口腔医学

上海口腔医学 ›› 2025, Vol. 34 ›› Issue (2): 218-224.doi: 10.19439/j.sjos.2025.02.019

• 临床总结 • 上一篇    

带蒂颊脂垫/黏骨膜复合瓣技术预防及封闭口腔上颌窦瘘的效果评价

邹姣姣1,2, 侯笑茹1,2,3, 王淋1,2, 李立峰1,2,3, 李彦秋1,2,3, 虎小毅1,2,3,*, 邢晓涛1,2,3,*   

  1. 1.西安交通大学口腔医院,陕西省颅颌面精准医学研究重点实验室,陕西 西安 710000;
    2.陕西省牙颌疾病临床研究中心,陕西 西安 710000;
    3.西安交通大学口腔医院 创伤整形外科, 陕西 西安 710000
  • 收稿日期:2024-06-26 修回日期:2024-09-17 出版日期:2025-04-25 发布日期:2025-05-15
  • 通讯作者: 邢晓涛,E-mail:xingxiaotao110@126.com;虎小毅,E-mail:doctorhu@xjtu.edu.cn。*共同通信作者
  • 作者简介:邹姣姣（1988-）,女, 硕士,E-mail: 1134253416@qq.com
  • 基金资助:
    国家自然科学基金（32300981）; 西安交通大学口腔医院院级项目基金（xjkqxjs2023-15）; 陕西省卫生健康学科带头人访学研修经费

Application of pedicled buccal fat pad/mucoperiosteal composite flap technique to prevent and seal oroantral fistula

Zou Jiaojiao1,2, Hou Xiaoru1,2,3, Wang Lin1,2, Li Lifeng1,2,3, Li Yanqiu1,2,3, Hu Xiaoyi1,2,3, Xing Xiaotao1,2,3   

  1. 1. Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University. Xi'an 710000;
    2. Laboratory Center of Stomatology, College of Stomatology, Xi'an Jiaotong University. Xi'an 710000;
    3. Department of Cranio-Maxillofacial Trauma and Plastic Surgery, College of Stomatology, Xi'an Jiaotong University. Xi'an 710000, Shaanxi Province, China
  • Received:2024-06-26 Revised:2024-09-17 Online:2025-04-25 Published:2025-05-15

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摘要： 目的：总结并探讨带蒂颊脂垫/黏骨膜复合瓣在预防及封闭口腔上颌窦瘘中的效果。方法：选择12例采用带蒂颊脂垫/黏骨膜复合瓣技术关闭上颌骨后部术区创口的患者。术中清除上颌后部病损后,制备带蒂颊脂垫并衬垫于局部黏骨膜下方,形成复合瓣以关闭创口。对患者的基本信息（年龄、性别、所患疾病及临床症状等）、影像学特征、手术过程及效果以及术后局部功能等进行回顾性分析。结果：12例患者中,男女比例为1∶1,平均年龄（35.83±20.17）岁。其中,8例为上颌后牙区囊性病损, 3例为口腔上颌窦瘘,1例为上颌骨粉碎性骨折。所有手术均涉及上颌后牙区,毗邻上颌窦。术前患者表现为肿痛、口臭及咬合紊乱等临床症状。CT显示上颌骨后部可见骨质破坏,涉及多颗牙位,部分病例伴有牙阻生,病变范围与上颌窦关系密切,术区颊侧骨质吸收或破坏。术中拔除病变牙并清除病灶后,颊侧骨质保留较少,采用带蒂颊脂垫/黏骨膜复合瓣技术关闭创口。随访期间,12例患者均实现一期愈合,未出现口腔鼻腔瘘,颊部及口腔前庭沟未见明显形态及功能异常。结论：口腔上颌窦瘘及上颌骨后部病损伴骨吸收采用带蒂颊脂垫/黏骨膜复合瓣技术封闭创口,有利于术后封闭及预防口腔上颌窦瘘,改善临床症状。

关键词: 口腔上颌窦瘘, 颊脂垫瓣, 黏骨膜瓣, 囊性病变, 上颌骨后部

Abstract: PURPOSE: To summarize and evaluate the clinical effectiveness of the pedicled buccal fat pad combined with a mucoperiosteal composite flap in preventing and closing oroantral fistula. METHODS: This study included a total of 12 patients who underwent closure of surgical incisions following treatment of posterior maxillary lesions using a pedicled buccal fat pad combined with a mucoperiosteal composite flap. In all cases, the pedicled buccal fat pad was placed beneath the local mucoperiosteum to form a composite flap for incision closure. The retrospective analysis encompassed patients’ baseline data, including age, gender, diagnosis, clinical symptoms, imaging characteristics, surgical procedures, and treatment outcomes. Additionally, the analysis included an evaluation of the local functional outcomes in the operative area. RESULTS: Among the 12 patients, there was an equal distribution of males and females (1∶1 ratio), with an average age of (35.83±20.17) years. Among them, 8 cases had cystic lesions in the maxillary posterior region, 3 cases had oroantral fistula, and 1 case had maxillary comminuted fracture. All patients (100%) underwent surgery involving the maxillary posterior dental region adjacent to the maxillary sinus. Preoperative symptoms included swelling, pain, halitosis, and occlusal disorder. CT imaging revealed that bone destruction in the posterior maxilla frequently affected multiple teeth, often with impacted teeth, and showed a close association with the maxillary sinus. Buccal bone resorption or destruction was the predominant feature in the operative area, and after removal of the diseased teeth, limited buccal bone remained. Wound closure was achieved using a buccal fat pad/mucoperiosteal composite flap technique. During the follow-up period, all 12 patients healed successfully, with no occurrences of oral-nasal fistula. Additionally, no significant changes in buccal morphology or vestibular groove were observed. CONCLUSIONS: The use of a pedicled buccal fat pad combined with a mucoperiosteal composite flap is effective in sealing and preventing oroantral fistula, improving clinical symptoms in cases involving oroantral fistula and maxillary posterior bone resorption during surgery.

Key words: Oroantral fistula, Buccal fat pad flap, Mucoperiosteal flap, Cystic lesions, Posterior maxilla

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