咽旁间隙巨大肿瘤的手术径路探讨

Surgical Approaches to Resection of Bulky Tumors in Parapharyngeal Space

目的:探讨咽旁间隙巨大肿瘤切除的最佳手术径路。方法:2009-11—2011-05,笔者对6例咽旁间隙巨大肿瘤患者施行肿瘤切除手术,其中4例采用下颌正中截骨径路,2例采用了颏孔前截骨径路。结果:采用下颌正中截骨及颏孔前截骨径路,术野暴露充分,肿瘤切除安全、完整,术后愈合良好,无1例术后出现咬合关系紊乱。平均随访22个月(14～31个月),均未发现肿瘤复发。除1例下颌神经血管束因与瘤体粘连而切除外,无任何神经损伤症状。结论:下颌正中截骨和颏孔前截骨径路是咽旁间隙巨大肿瘤切除术的理想手术径路,符合肿瘤外科、美容外科和功能外科原则。

Objective： To discuss the most appropriate surgical approaches to the resection of the bulky tumors in parapharyngeal space. Methods： From November 2009 to May 2011, six patients suffering bulky tumors in parapharyngeal space were underwent operation. Surgical approach through the symphysis of the mandible was carried out in 4 cases, while the osteotomy selected at the region of mental foramen treating the other 2 cases. Results： The operative field was exposed fully and tumors were removed completely and successfully using these two approaches. Postoperative recovery was good and no occlusion disorders were found. There was no recurrence within 14~31 months follow-up period. One patient complicated with nerve symptom due to adhesion and removal of the neurovascular bundle of mandibular nerve. Conclusion： The osteotomies through the symphysis of mandibular and/or the mental foramen area are the ideal approaches for the resection of huge tumors in parapharyngeal space, and in compliance with the principles of tumor surgery, plastic and reconstructive surgery, and cosmetic surgery.