Chemotherapy-induced Nasopharyngeal Stenosis Treated with Bilateral Facial Artery Musculomucosal Flaps
Chemotherapy-induced Nasopharyngeal Stenosis Treated with Bilateral Facial Artery Musculomucosal Flaps
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双侧面动脉肌粘膜瓣治疗化疗所致鼻咽部狭窄
DOI：
10.1097/gox.0000000000003041
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Kishi Kazuo
中科院分区：
文献类型：
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作者：
Nishimon Mari;Ochiai Hiroko;Watanabe Shiho;Hirata Eri;Oka Aiko;Yazawa Masaki;Kishi Kazuo
我们报告的第一例50岁的妇女谁开发鼻咽狭窄（鼻咽狭窄）化疗后恶性淋巴瘤。化疗是有效的，但治疗后出现了腹泻。咽部和软腭的肿瘤坏死并变成瘢痕组织，这引起了痉挛，特别是在软腭的尾部。由于狭窄，患者出现鼻塞和阻塞性睡眠呼吸暂停。患者接受了2次手术以解决狭窄：第一次是狭窄的简单切口，第二次是Z成形术和咽后壁粘膜移植。然而，在这两次手术后不久，复发。我们使用双侧以走廊为基础的面动脉肌粘膜（FAMM）皮瓣作为复发性狭窄的解决方案，它可以有效地防止进一步狭窄。皮瓣血供稳定，皮瓣大小足以弥补组织缺损。双侧FAMM皮瓣的使用使两侧的鼻咽部得以矫正，并且皮瓣提供足够的牵拉力量，通过从两侧牵拉来保持鼻咽空间的扩张。术后患者鼻塞症状减轻，睡眠质量明显改善。术后患者鼻咽功能良好，无鼻咽功能不全症状。我们的研究结果表明，双侧FAMM皮瓣是一个合适的方法来挽救顽固性病例。
We report the first case of a 50-year-old woman who developed nasopharyngeal stenosis (NPS) after chemotherapy for malignant lymphoma. The chemotherapy was effective, but NPS developed following treatment. The tumors of the pharynx and soft palate became necrotic and turned into scar tissue, which caused NPS, especially in the caudal part of the soft palate. The patient developed nasal obstruction and obstructive sleep apnea due to the stenosis. The patient underwent 2 surgeries to resolve the NPS: the first was a simple incision of the stenosis, and the second was Z-plasty and mucous membrane transplantation from the posterior pharyngeal wall. However, the NPS recurred soon after these 2 surgeries. We used bilateral inferior-based facial artery musculomucosal (FAMM) flaps as a solution for recurrent NPS, and it was effective in preventing further stenosis. The blood supply to the flaps was stable, and the size of the flaps was enough to compensate for the area of tissue deficit. The use of bilateral FAMM flaps allowed both sides of the NPS to be corrected, and the flaps provided sufficient retracting strength to keep expanding the nasopharyngeal space by pulling from both sides. After the operation, nasal obstruction was decreased, and the sleep quality of the patient improved significantly. The velopharyngeal function was maintained, and there was no symptom of nasopharyngeal insufficiency. Our results suggest that the bilateral FAMM flap is a suitable method to rescue intractable cases of NPS.