经口腔上颌结节入路切除咽旁间隙肿瘤

Excision of superior parapharyngeal space neoplasms via maxillary tubercle approach

目的探讨经上颌结节入路切除咽旁近颅底肿瘤的可行性。方法 5例咽旁近颅底区肿瘤病例,切开上颌牙龈和上颌结节黏膜,拔除上颌第2、3磨牙,并凿除牙槽骨和上颌结节骨,切断附着于翼突和上颌结节处的翼内外肌,凿断翼突,沿肿块包膜外分离,或切开包膜,切除肿瘤。尽量保留受累神经。结果神经鞘瘤4例,脑膜瘤1例,均完整切除,随访6个月至7年,无一例肿瘤复发。2例听力下降患者中1例术后鼓室粘连,听力下降症状未改善;另1例分泌性中耳炎症状消失。3例出现不同程度下唇和舌缘麻木,1例半年后麻木消失,另2例下唇麻木持续存在。伤口感染3例,经抗感染治疗均痊愈。结论上颌结节入路是切除咽旁近颅底区良性肿瘤的一种有效方法。

Objective To explore the methods for excising the tumors in the superior parapharyngeal space and near the skull base through maxillary tubercle approach.Methods Five cases of superior parapharyngeal space and skull base neoplasms were involved.The posterior maxillary gum and the mucous membrane of the maxillary tubercle were incised;the second and the third molars of the maxillary were extracted;the alveolar bone and the bone of the maxillary tubercle were excised,the internal and the external pterygoid muscles which attach to the pterygoid process and the maxillary tubercle were excised.The tumors were scooped out along the outside or inside of the envelope,remaining the involved nerves as far as possible.Results Four neurilemmomas and one meningioma were completely excised.After half to seven years＇ follow-up,there was none recurrence;one patient suffered tympanic cavity adhered,and the auditory acuity has no improvement;three remained numbness of lower lip and lingual margin,which disappeard half year later in one of them.Three surgical wounds were infected,and all recovered with anti-infection treatment.Conclusion The approach for excising the superior parapharyngeal space neoplasms through the maxillary tubercle is effective.