下颌下入路联合下颌支冠状劈开切除咽旁肿瘤的探讨

A post submandibular approach together with osteotomy in the vertical ramus outside of the mandibular foramen in treatment of tumors invading parapharyngeal space

目的:探讨下颌下入路联合下颌支冠状劈开切除咽旁肿瘤的可行性。方法:术前影像学检查显示初发咽旁肿瘤患者10例,男6例,女4例,年龄19~62岁,平均40.3岁。神经鞘瘤2例,脂肪瘤1例,脊索瘤1例,多形性腺瘤4例,腺淋巴瘤1例,腺样囊性癌1例。肿瘤大小约4cm×4cm^6cm×8cm。所有患者行下颌下入路联合下颌支冠状劈开,切除咽旁肿瘤。术后腺样囊性癌和脊索瘤患者接受约50Gy的辅助放疗。结果:10例患者咽旁肿瘤完整切除;1例患者轻度面瘫,经神经营养治疗1个月康复,其余病例无面瘫、下唇麻木等并发症。术区一期愈合。经5~28个月随访,无肿瘤复发。结论:下颌下入路联合下颌支冠状劈开切除咽旁肿瘤术式安全、可靠。

PURPOSE： To assess the reliability and safety of the post submandibular approach together with osteotomy in the vertical ramus outside of the mandibular foramen in treatment of tumors invading parapharyngeal space. METHODS： Ten primary parapharyngeal-space tumors were treated with a post submandibular approach together with osteotomy in the vertical ramus outside the mandibular foramen. Primary lesions were pleomorphic adenoma, schwannoma, Warthin’s tumor, lipoma, chordoma, and adenoid cystic carcinoma. Tumor size ranged from 4 cm×4 cm to 6 cm×8 cm. Patients with malignant tumors who underwent surgical resection also received adjuvant radiotherapy for about 50Gy. RESULTS： All the tumors were removed completely. No patient exhibited any permanent postoperative complication or other dental complications from this surgical approach. One patient had slight transient postoperative facial paralysis, which resolved spontaneously nearly one month. The patients were followed up for 5 to 28 months. No recurrence was encountered. CONCLUSIONS： The post submandibular approach together with osteotomy in the vertical ramus outside of the mandibular foramen for tumors in the parapharyngeal space is reliable and safe.