颞肌在翼腭窝肿瘤侵犯软硬腭术后缺损修复中的应用

Modified Barbosa combined with lateral temporal approach for tumor in the pterygopalatine fossa involving the hard and/or soft palate with temporalis muscle reconstruction

目的评价翼腭窝肿瘤侵犯硬软腭术后组织缺损颞肌修复重建的效果。方法在1998年2月～2003年1月5年,共有11例患者接受手术治疗。11例患者中,男8例,女3例。年龄31～68岁,平均49.6岁。11例患者均为翼腭窝肿瘤侵及硬软腭者,手术均采用改良Barbosa联合侧颞部切口进路摘除肿瘤,术中遗留的硬、软腭缺损采用患侧前和中颞肌瓣修复。结果11例患者中,粘液表皮样癌4例,腺样囊性癌3例,骨肉瘤1例,低分化腺瘤2例,成釉细胞瘤1例。硬软腭缺损面积为30～50%,术后创面均一期愈合,肌瓣无坏死,4周后肌瓣口腔面粘膜化。术后患者进食与术前无差异,腭咽闭合无影响。结论使用颞肌瓣修复翼腭窝肿瘤侵犯硬、软腭术后缺损是一种有效的好方法。

Objective To evaluate the effects of a modified Barbosa combined with lateral temporal approach for tumor in the pterygopalatine fossa involving the hard and/or the soft palate with temporalis muscle reconstruction. Methods Eleven patients（8 male, 3 female;age range：31-68） were treated by a modified Barbosa combined with lateral temporal approach for resection of the tumor in pterygopalatine fossa involving the hard and/or the soft palate. The lesions included 4 low-grade mucoepidermoid carcinoma, 3 adenoid cystic Carcinoma, 2 low-grade adenoid carcinoma, 1 osteosarcoma, 1 ameloblastoma. The anterior and/or middle temporalis myofascial flap were used for reconstruction of defects of the hard and/or soft palate. Results All the flaps in this group of patients survived, and none required postoperative intervention to maintain flap viability. The entire flap remucosalized 4 weeks after surgery. Ten patients were able to resume their preoperative diets. No velopharyngeal insufficiency was encountered. Conclusion This construction is especially useful in treating patients with tumor of the pterygopalatine fossa involving the hard and/or the soft palate.