面颊外翻颌咽联合入路切除咽旁间隙巨大肿瘤

Removal of giant parapharyngeal space tumors via buccal flap elevation combined with mandibular pharyngeal approach

目的:介绍一种新的切除咽旁间隙巨大肿瘤的手术入路,探讨其可行性和安全性。方法:2005年1月—2009年6月,对9例咽旁间隙巨大肿瘤,采用面颊外翻颌咽联合入路进行手术。取下唇外侧及下颌下切口,在颈阔肌和表情肌浅面游离皮瓣并向外侧掀起,沿咬合线切开面颊肌,继而向后切开磨牙后区及咽侧壁黏膜,从口内及下颌下2个方向充分显露瘤体,完整切除肿瘤。结果:9例患者均顺利完成手术,术中观察到此入路术野大、显露充分,可以完整切除肿瘤,并且利于彻底止血。术后未发生面神经麻痹和术腔感染。结论:面颊外翻颌咽联合入路将口内外切口进行有效地结合,术野清楚,尤其口内切口显露充分,适合咽旁间隙巨大肿瘤的切除,特别是向颊部侵犯的肿瘤。

PURPOSE： To introduce a new surgical approach for removal of giant parapharyngeal space tumors,and discuss the feasibility and security.METHODS： We removed 9 cases of giant parapharyngeal space tumors via buccal flap elevation combined with mandibular pharyngeal approach from January 2005 to June 2009.First,Lateral lip and submandbular incision was performed,the skin flap was elevated on the surface of platysma and mimetic muscle and turned up outward,and then the cheek muscle was incised along the line of occlusion.Secondly,the retro molar and the lateral wall of pharynx mucosa was incised.Last,tumor zone was exposed both intraorally and submandibularly,and the tumor was excised completely.RESULTS： Nine patients had successful operation.During the operation we could excise the tumor entirely because the view field was clear and broad,and the tumor could be fully exposed.It was good for complete homeostasis and there was no complication such as facial nerve palsy and infection.CONCLUSION： This approach combined intraoral and extraoral incision,and made the surgical field clear,especially the intraoral incision could be fully disclosed.So it was suitable for excision of giant parapharyngeal space tumor,especially for tumors already having buccalis invasion.