颅底—颞下颌关节区骨巨细胞病变的切除及修复

Resection and reconstruction of giant cell lesion of bone in skull base-temporomandibular joint region

目的:探讨发生于颅底—颞下颌关节区的骨巨细胞病变的手术切除特点及修复原则。方法:1994年3月～2007年7月共手术治疗颅底—颞下颌关节区骨巨细胞病变18例,12例行颅颌联合手术。15例病变全部切除,3例近全切除,仅1例切除部分硬脑膜并修补。对于术后缺损,17例用邻近带蒂组织瓣如颞肌系统瓣、胸锁乳突肌瓣修复,1例用游离背阔肌肌皮瓣修复;4例用钛板重建颧弓,6例用钛网重建颅底,2例分别用人工关节和游离髂骨重建颞下颌关节。3例近全切除者加用术后放疗。结果:除1例术后第3天发生脑脊液漏,经保守治疗康复,其余无并发症。所有18例术后外形基本对称,术前各种症状明显改善。16例在随访期间(6个月～10a)未出现复发,2例失访。结论:对发生于颅底-颞下颌关节区的骨巨细胞病变,应力求根治性切除,硬脑膜缺损应予修补。用邻近的带蒂组织瓣修复软组织缺损,钛板或钛网修复骨组织缺损,可获得满意的外形,较大的缺损可用游离组织瓣修复。

PURPOSE：To explore the resection and reconstruction principles of giant cell lesion of bone in the skull base-temporomandibular joint region.METHODS：From March 1994 to July 2007,eighteen patients with giant cell lesion of bone in the skull base-temporomandibular join region were treated,12 patients underwent cranio-mandibular resection.Radical resection and subtotal resection were performed in 15 patients and 3 patients,respectively.Dura mater was partially removed and restored in only 1 patient.Regional flaps such as temporalis system flaps and sternocleidomastoid muscular flap were applied to repair postoperative defect in 17 patients.Free latissimus dorsi myocutaneous flap was applied in 1 patient.Titanium plate was used to reconstruct zygomatic arch in 4 patients,titanium mesh was used to reconstruct skull base in 6 patients.Temporomandibular joint was reconstructed by condylar prosthesis and free iliac bone graft in 2 patients,respectively.Postoperative radiotherapy was performed in 3 patients who underwent subtotal resection.RESULTS：Leakage of cerebrospinal fluid was found in only 1 patient from postoperative 3 days and stopped by conservative treatment.No other complications were found.Postoperative appearance was symmetrical and various kinds of preoperative symptoms were improved obviously in all 18 patients.Recurrences were not found in 16 patients during the follow-up periods（6 months to 10 years） and other 2 patients were lost follow-up.CONCLUSION：Radical resection would be an ideal therapy for giant cell lesion of bone in the skull base-temporomandibular joint region,dura mater defect should be repaired.Optimal facial contour can be achieved by reconstruction of soft tissue defect with regional flap andbone defect with titanium plate or mesh.Major defect should be reconstructed with free flap.