腮腺筋膜和耳大神经保留的改良方法

A modified approach to remain major auricular nerve and parotid fascia in parotidectomy

目的:介绍一种腮腺切除术中保留耳大神经和腮腺筋膜的改良方法。方法:取常规S形切口,在腮腺筋膜浅面先向前游离皮瓣至腮腺近前缘,再于耳垂前1cm处纵形切开腮腺筋膜,在腮腺筋膜深面、腮腺组织表面向后游离至胸锁乳突肌,形成皮肤筋膜瓣。在游离过程中,将耳大神经主干及耳垂支、耳后支保留在皮肤筋膜瓣上,最后向前游离筋膜瓣。完成腮腺切除后,将前、后腮腺筋膜瓣折叠,拉紧缝合。结果:45/46例患者获得随访。术后3例分别在5个月、9个月和11个月出现轻度Frey综合征。9例术后出现耳垂暂时麻木,1～3个月后恢复感觉。下颌后凹陷不明显,无涎瘘发生。结论:改良的手术方法能完好地保留腮腺筋膜和耳大神经耳垂支、耳后支,显著降低相应并发症的发生。

PURPOSE： To introduce a new method of remaining major auricular nerve and parotid fascia in parotideetomy. METHODS： Traditional S-shaped incision was used, the skin flap was separated to the anterior border of the parotid gland on the superficial of parotid fascia, then the deep parotid fascia was cut longitudinal in front of the auricular lobule. After that, the skin flap was separated backward to the stern cleidomastoid muscles. The major auricular nerve and its two branches were kept in the skin flap. Finally, the fascia flap was freed forward, the two sides of the parotid fascia were drawn tight and sutured together. RESULTS： 45 out of 46 patients were followed up, 3 of them developed Frey＇s syndrome, and 11 months after surgery, respectively; 9 patients had temporary auricular lobule numb and recovered 1 to 3 months later. No salivary fistula was noted. CONCLUSIONS： The new approach can remain parotid fascia and major auricular nerve branches completely with minor complications.