改良耳后区入路下颌下腺摘除术

SUBMANDIBULAR SIALOADENECTOMY BY A MODIFIED RETROAURICULAR APPROACH

目的总结改良耳后区入路下颌下腺摘除的手术方法及疗效。方法 2008年10月-2009年4月,收治8例下颌下腺良性病损患者。男女各4例;年龄32～54岁,平均38.5岁。其中下颌下腺导管结石伴下颌下腺炎5例,下颌下腺多形性腺瘤3例。病程2个月～5年。术中皮肤切口设计于耳后沟和发际线,保留颌外动脉、面前静脉,仅结扎其进入下颌下腺的分支血管,摘除下颌下腺及病变组织。结果手术均完整摘除下颌下腺及瘤体。手术时间45～75min,平均60min。术后切口均Ⅰ期愈合,无面神经下颌缘支或舌神经、舌下神经麻痹发生。1例因术中过度牵拉导致术后皮瓣血运不佳,未经特殊处理24h后恢复正常;其余皮瓣术后血运均正常。术后患者均获随访,随访时间1～6个月,平均3个月。切口瘢痕隐蔽,外观满意。结论改良耳后区入路下颌下腺摘除术具有操作简便、并发症少、术后外观较好等优点。

Objective To evaluate the efficacy and the surgical procedures of submandibular sialoadenectomy by a modified retroauricular approach. Methods Between October 2008 and April 2009, 8 patients with benign submandibular gland disorders underwent removal of benign submandibular gland lesions using a retroauricular approach. There were 4 males and 4 females with an average age of 38.5 years （range, 32-54 years）, including 3 pleomorphic adenoma and 5 chronic sialadenitis with sialolithiasis. The disease duration was from 2 months to 5 years. The anterior facial vein and the facial artery were reserved only by the ligation of branching vessels in the submandibular gland. Results Submandibular sialoadenectomy were successfully performed in 8 cases. The operative time was 45-75 minutes （mean, 60 minutes）. All incisions obtained healing by first intention. No nerve paralysis occurred, including marginal mandibular branch of the facial nerve, the lingual nerve, and hypoglossal nerve. One patient had poor blood circulation of flap due to excessive traction during operation, but it returned normal after 24 hours without special treatment. Other flaps had good blood circulation. All patients were followed up 1-6 months （mean, 3 months）. The incision scars were hidden with satisfactory appearance. Conclusion The modified retroauricular approach has some advantages such as simple operation, better cosmetic outcome, and no complication.