改良面中掀翻径路上颌骨手术临床经验

Maxilla surgery by a modified mid-facial degloving approach

目的探讨改良的面中掀翻径路手术治疗累及上颌骨的鼻腔、鼻窦肿瘤的临床应用情况。方法根据28例鼻腔、鼻窦良恶性肿瘤患者的病变部位、临床分期等不同情况,采用改良的面中掀翻径路暴露术野手术,观察术中显露、出血及手术难易,对比肿瘤患者术后局部外观、功能损害及预后。结果改良的面中掀翻径路上颌骨手术过程顺利,外观术后面部轻度水肿,无明显凹陷,无并发症发生;随访28例采用面中掀翻径路手术患者,术后3～5个月面部无明显畸形,术腔有干痂形成,3例有口鼻瘘。再后出现患侧鼻翼、鼻唇沟处凹陷。部分患者存在开放性鼻音。结论面中掀翻径路手术可以完成上颌骨扩大切除以及部分切除手术,具有手术时间短、损伤轻、恢复快,部分功能保留好以及无瘢痕等优点。

Objective To explore the clinical experience in treating nasal and sinus tumor involved maxilla. Methods Extirpation of 28 cases of tumors of the maxillary sinus by a modified midfacial degloving approach was studied during the period from 2001 to 2010 at our department. Intra-operative exposure, bleeding and surgical difficulty were observed and post-operative local appearance, functional impairment and prognosis, including the exposure for adequate tumor re- section and the preservation of as much as possible functional tissue integrity were compared. Results 28 patients suc- cessfully underwent the planned procedures through the midfacial degloving approach for the treatment of the maxilla le- sions without significant complications. The patients had immediate post-operative face edema and no infection oc- curred, but the post-operative deformity was not obvious within 3 to 5 months. Late complications, such as persistent palatal fistula occurred in 3 patients. Nasal crusting in the operative cavity were found with recent surgery effect as clean cut in all patients. About six months after the surgery, a depressed deformity in the face or the nasolabial fold were found. Rhinolalia aperta was also observed among patients with palate removal. Conclusions The midfaeial degloving approach offers good exposure for removal of extended or partial maxilla with excellent cosmetic results. Other advanta- ges such as less operative time, less damnification, quicker recovery, and more function remaining are obvious. The mid-facial degloving technique can be considered as a valuable procedure with low mortality and excellent cosmetic out- come.