沿下唇正中及颌下入路切除上颌骨

New and practical approach of full maxillectomy by path along lower lip and lower jaw

目的根据上颌骨解剖学的特点，探讨经下唇、颌下入路行上颌骨切除术的方法及优势。方法24例患者采用这种入路施行上颌骨切除术，即下唇正中至颏下，经患侧颌下至乳突前下方。切口设计避开了上唇及眶下区，最大程度地保持了上唇及面中部软组织结构的完整性，面部切口暴露短，且有利于上颌骨恶性肿瘤扩大根治术以及同期施行颈淋巴清扫术。结果经过0．5～2．0年的术后随访，疗效满意。患者无论是采用单一手术或辅以放、化疗均未出现颌面部皮肤的坏死或口角歪斜等并发症，但有术后短期的下唇麻木。结论沿下唇正中及颌下入路切除上颌骨，不但能充分显露术野、完整切除上骨的恶性肿瘤，并能较满意地保持术后面部外形和功能。

Objective To find a new and practical approach of full maxillectomy by the path along lower lip and the lower jaw according to the anatomic characteristics of maxilla. Methods From January 1997 to January 2005, 24 cases underwent full maxillectomy in this new approach, and the excision line began from the middle of the lower lip, and the chin went through the mandibular margin to the anterior lower of the same lateral papillary. By the design of excision line, super lip and infraorbital areas had been evaded from injury, and the integrality of the super lip and soft tissue of middle face construction had gained reservation ultimately. On the other hand, this operation path brought a little face excision and was a convenient radical cure of maxilla cancer as well as neck lymphonodus clean. Results After the follow-up from six months to two years, the results have been proved satisfactory. All patients who maybe only xeceived operation or received chemotherapy or radiotherapy post-operation did net suffer from any complications such as necrosis or the askew of mouth and so on, except the short-term removing of lower lip after operation. Conclusion This new surgical excision line design not only can expose operation area clearly and remove maxilla cancer successfully but also, can reserve face shape and function satisfactorily, h accords with the surgical idea of removing focus and conserving function and is worthy to be recommended.