Anatomy And Clinical Application Of Buccal Mucosal Flap In Reconstruction Of Lacrimal Passage

Objective Lacrimal canaliculus rupture is a common ophthalmological disease,mainly to overflow tears,depending on the material unclear as its main symptoms.Lacrimal sac secondary to severe infection and even blindness and other serious consequences,seriously affecting the quality of life and work.This study is to explore a satisfactory technique for lacrimal duct reconstruction through literature analysis,anatomy and clinical studies.For the future surgical treatment of lacrimal duct provide a new reference.Methods 6 cases of cranial anatomy were performed,and 4 cases of skull specimens were subjected to gelatin lead oxide CT perfusion imaging.Anatomical data were collected to obtain the following information:(1)Lacrimal duct anatomy of the location and structure.(2)Buccinator mucosal flap selected locations and structures.(3)Buccal mucosal flap muscle blood supply sources out of shape and direction.(4)Major blood vessels of the head and face course and distribution.Based on the above information,the feasibility of buccal mucosal flap reconstruction lacrimal duct surgery and anatomic details needing attention during operation are analyzed.From May 1999 to December 2016,11 patients with ruptured lacrimal canaliculi were treated with lacrimal buccal mucosa flap for lacrimal passage reconstruction and follow-up for 5 years after operation to obtain the surgical operation-related data and follow-up data.Results In the 6 cases(4 males and 2 females)of conventional anti-corrosion and skull specimens perfused with red latex through the facial artery.Superior labial arbial artery began in the root of the nose and mouth under the connection line 1/3,between the lip mucosa and the muscular layer was wavy,And distributed to a number of small branch inside of the upper lip.In 30 cases of cranial specimens,the upper lip artery anastomosis located in the midline at 5 cases(3 males and 2 females);Anastomosis is located in the left side of the midline in 1 cases(1 males and 0 females);Anastomosis is located in the right side of the midline in 0 cases.In 6 cases of craniocerebral specimens,the lower naso-alar marginal artery can be clearly observed.the lower naso-alar marginal artery are located in the Orbicularis oris deep,from the outer side of the alar base,along the nasal muscle,the inferior border of the nasal septum,and radiate many arterioles inwardly.Gelatin lead oxide perfusion CT imaging in 4 cases,from the image it can be seen that the main sources of the buccal mucosal flap pedicled blood supply are the facial artery and the upper lip artery and its branches,the lower naso-alar marginal artery and its tiny perforating blood vessels.A total of 11 patients were enrolled in the study,both of whom were severe lacrimal passages damage or who had severe obstruction of the lacrimal duct,Including 9 males and 2 females,aged 24-51 years,mean age 32 years,were unilateral lacrimal injury,including 7 cases of right and left in 4 cases.Trauma resulting in 8 cases,lacrimal duct anastomosis postoperative poor results in 3 cases.11 patients were applied buccinator myomucosal flaps were lacrimal duct reconstruction,9 cases completely eliminate symptoms in patients with epiphora,2 patients symptoms have been significantly improved.Patients were followed up for a maximum of 5 years,a minimum of 1 year,no other complications were found after operation.Buccinator myomucosal flaps were all survived,new lacrimal passage completely smooth,patient satisfaction.Conclusion(1)Buccinator myomucosal flap surgery used mainly for blood supply from superior labial arbial artery and its branches,partly from the lower naso-alar marginal artery?(2)Clinical application of buccinator myomucosal flap reconstruction lacrimal duct,excellent surgical results,no significant postoperative follow-up complications,good long-term results,which is a less complication,low recurrence rate,and safe and easy operation method.