改良面中掀翻径路上颌骨手术治疗鼻腔、鼻窦肿瘤

Maxilla Surgery with Modified Midfacial 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30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30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 30 cases with tumors of the maxillary sinus with modified midfacial degloving approach were studied during the period from 2001 to 2011 at our department. Intraoperative exposure,bleeding and surgical difficulty and compared postoperative local appearance, functional impairment and prognosis were observed. Including the exposure for adequate tumor resection and the preservation of functional tissue integrity as much as possible. Results Thirty patients underwent the planned procedures successfully with the midfacial degloving approach for the treatment of the maxilla lesions withoul significant complications. The patients had immediate postoperative face edema and no infection occurred,but the postoperative deformity not obvious within 3 to 5 months. Late complications occurred,such as persistent palatal fistula in 3 patients. Nasal crusting in operative cavity were fi）und with recent surgery effect as clean cut in all patients. About six months after the surgry,the depressed deformity in the face or the nasolabial foht were found. Rhinolalia aperta also observed among patients with palate removal. Conclusion The midfacial degloving approach offers a good exposure to resect extended or partial maxilla with excellent cosmetic results. Other advantages such as less operative time,less danmification, quicker recovery, more function remained are obvious. The midfacial degloving technique can be considered as a valuable procedure with low mortality and excellent cosmetic outcome.