NGHIÊN CỨU PHẪU THUẬT CẮT XƯƠNG HÀM TRÊN DO UNG THƯ HỐC MŨI - KHOANG MIỆNG CÓ TÁI TẠO BẰNG VẠT DA CƠ XƯƠNG MÁC TỰ DO

Abstract

Introduction: Nasal cavity–oral cavity cancer can invade the maxilla, necessitating maxillary resection to achieve oncologic control. However, maxillary defects significantly impact speech, swallowing, and facial aesthetics. To address these challenges, free fibular osteocutaneous flap reconstruction has emerged as a preferred technique due to its ability to provide bone, soft tissue, and skin in a single-stage procedure. This approach effectively restores maxillofacial structure and function, improving patients’ quality of life. Objective: This study aims to evaluate the outcomes of maxillary resection for nasal cavity–oral cavity cancer with reconstruction using a free fibular osteocutaneous flap. Methods: A prospective case series was conducted on 12 cases who underwent maxillary resection with free fibular osteocutaneous flap reconstruction at the Otorhinolaryngology Department of Cho Ray Hospital from December 2018 to June 2024. Results: Among 12 cases who underwent maxillary resection with free fibular osteocutaneous flap reconstruction, including partial unilateral maxillectomy with invasion of the overlying skin (2 cases), partial unilateral infrastructure maxillectomy (2 cases), total bilateral infrastructure maxillectomy (4 cases), and total unilateral maxillectomy with partial contralateral maxillectomy (4 cases). All patients demonstrated flap viability and good wound healing. Postoperative complications were minimal, with hematoma at the donor site in 1 case, soft palate dehiscence in 2 cases and partial venous congestion in 1 case. The reconstructed flaps effectively separated the oral and nasal cavities in all cases. Patients were able to resume oral feeding and experienced no significant speech impairment. Conclusion: Maxillary resection with free fibular osteocutaneous flap reconstruction is an effective approach for restoring oral function and maintaining speech and swallowing abilities. The procedure exhibits a high rate of success coupled with a minimal incidence of perioperative complications, thereby establishing it as an effective method for the reconstruction of maxillary defects.