不同类型下颌骨截骨在咽旁肿瘤切除术中的应用

Applications of mandibulotomy to the resection of parapharyngeal space tumors

目的探讨颞下、咽旁肿瘤切除的最佳下颌截骨方式。方法回顾分析1996年1月～2003年12 月间采用下颌骨截骨方式切除侵及咽旁颞下区肿瘤21例的临床资料,经下颌升支垂直截骨11例,下颌颏孔前截骨7例,下颌角区截骨1例,下颌正中截骨2例。结果下颌骨截骨更适应于咽旁间隙的巨大肿瘤以及浸润性生长的恶性肿瘤的整块切除,各种截骨方式各具特点。结论下颌骨截骨方式的选择以肿瘤性质、部位、大小为标准,充分暴露瘤体为原则,在下颌骨各截骨方式中,经颏孔前下颌截骨与经下颌升支垂直截骨是处置侵入咽旁、颞下区的肿瘤的较好手术进路。

Objective To seek a better approach to mandibulotomy for the resection of tumors in the parapharyngeal space. Methods A review was presented for 21 parapharyngeal space tumor resection employed mandibulotomy between January 1996 and December 2003. Four approaches to mandibulotomy were applicated to remove tumors according to the site and size: through vertical ramus osteotomy (11 cases), through the mandibulotomy before mental tubercle (7 cases), through the angulus mandibulae osteotomy (1 case), and the middle of the corpus mandibulae osteotomy (2 cases). Results Mandibulotomy was especially indicated for removal of huge tumor or malignant tumor in the parapharyngeal space and facilitated the resection of tumor. There were different clinical features of different approaches to mandibulotomy. Conclusion According to the nature, site, size, and shape of the tumor, different mandibulotomy will be selected, which is important to the treatment effect. Mandibulotomy before mental tubercle and vertical ramus osteotomy can be taken as effective approaches to the removal of parapharyngeal space tumors.