髁状突肿瘤20例诊断治疗分析

Clinical analysis of 20 condylar tumors

目的探讨髁状突常见肿瘤的临床特点、影像学表现及手术治疗方法。方法选取20例髁状突肿瘤患者,术前行CT定位,所有患者均采用手术治疗,并对其影像学特点、手术入路、具体术式、术后髁状突的功能恢复等方面进行分析。结果本组术中14例采用耳前切口入路,6例采用下颌下切口入路,根据肿瘤切除后髁状突与关节顶间距大小的不同,采用直接关节成形术或喙突移植重建术,2例病情严重的患者肿瘤摘除后同期行正颌外科手术。20例患者术后髁状突不适及张口受限症状改善或消失,瘢痕浅,面部外形满意,无面神经损伤症状。复查6~48个月,均无肿瘤复发。结论颌面部CT对于髁状突肿瘤的定位及诊断至关重要。髁状突肿瘤应根据肿瘤性质、肿瘤大小及肿瘤切除后患者的咬合关系,采用不同的手术治疗方法。

Objective To investigate the clinical and imaging features,and surgical treatment for common temporomandibular joint tumors.Methods Twenty patients with condylar tumor were selected.All patients underwent preoperative CT positioning and were treated with surgery.Their imaging features,surgical approach,specific operation,postoperative condylar function recovery and other aspects were analyzed.Results 14 patients in this group were treated with preauricular approach and 6 cases under the submandibular approach.According to the gap between the condylar and the top of articular fossa after tumor resection,direct arthroplasty or coracoid process reconstruction was used.Two serious patients underwent orthognathic surgery after tumor removal.After surgery,the symptoms of condylar discomfort and limitation of mouth opening improved or disappeared.Scar was shallow,facial shape was basically satisfactory and there was no injury of facial nerve.The patients were followed up 6-48 months,there was no tumor recurrence.Conclusion Maxillofacial CT is very important for the diagnosis of condylar tumors.According to the nature and size of the tumor,and the occlusal relationship after tumor resection,we use different surgical treatment.