鼻咽癌在口腔颌面外科误诊的临床分析

THE CLINICAL ANALYSIS OF MISDIAGNOSIS OF NASOPHARYNGEAL CARCINOMA IN ORAL AND MAXILLOFACIAL SURGERY

目的 分析鼻咽癌临床误诊的原因从中吸取教训。方法 回顾性分析 6例病例。结果 误诊原因为 6例病人中 2例未及时作鼻咽部活检 ;2例因病灶位置隐蔽 ,经多次鼻咽部检查方才确诊 ;有 2例鼻咽部虽然经多次检查仍为阴性而取颌下肿块作了活检证实为转移癌灶。结论 鼻咽癌诊断困难原因主要有医生对此病警惕性不够和症状及体征不典型 ,活检取材位置不正确和深度不够。对面颈部包括腮腺区及颌下、颏下肿块患者要仔细检查鼻咽部 ,多次、多部位深取材活检才能得出正确的诊断。以及对鼻咽部多次检查阴性而腮腺区、颌下。

Objective To analyse the causes of misdiagnosis of nasopharyngeal carcinoma. Method Reviewing clinical materials on pre operation diagnosis and post operation pathological diagnosis of tumor in submental. Submandibular and parotid regional area ten years in our department. Authors analyse retrospectively six cases of clinical misdiagnosis of submental. Submandibular and parotid regional lymphatic metastasis of nasopharyngeal carcinomas. Results The causes of misdiagnosis: 1. without primary site biopsy (2 cases), 2.concealing tumors (2 cases) where the positive result was got eventually through multibiopsies, 3.too deep tumor where negative result was got by CT and the biopsy of transmitted tumor of neck. Conclusion It is not surprising that lumps in the neck is one of the most common presenting symptoms and signs for the nasopharyngeal carcinoma patient. The nasopharynx richly endowed with a network of lymphatics with access to both sides of the neck. On the other hand, submental, submandibular and parotid regional metastatic legions are clinically scare. So clinicians usually overlook nasopharyngeal carcinoma when the patient complain of the submental, submandibular and parotid regional mass firstly. In this study six cases are misdiagnosis pre operation. The main cause of diagnosis difficulty in nasopharyngeal carcinoma are alert for doctor, atypical symptoms and no proper biopsy. The basis for the diagnosis is a complete history and physical examination of nasopharynx. Indirect nasopharyngoscopy multibiopsy and MR can be supplemented for nasopharyngeal submucosal masses and no identifiable abnormalities. MR may define the extent of soft tissue involvement more accurately.