改良上颌骨外旋入路切除翼腭窝及颞下窝原发恶性肿瘤

Extirpation of primary malignancies in the pterygopalatine and infratemporal fossa via modified maxillary swing approach

回顾性分析2012年1月至2018年1月于湖南省肿瘤医院头颈外科就诊的5例翼腭窝及颞下窝原发恶性肿瘤患者资料(3例女性,2例男性,年龄13~67岁),患者均经术前活检确诊为恶性肿瘤,颅底CT和MRI检查评估后,接受全身麻醉下改良上颌骨外旋入路切除手术。5例患者均一次性整块切除肿瘤。4例患者切缘阴性,1例腺样囊性癌患者神经切缘阳性并接受术后放疗。术后常见并发症为面部皮肤麻木。随访时间12~57个月,无死亡病例。1例患者肿瘤于颞下窝处复发,于外院再次手术切除;其余患者均无复发。改良上颌骨外旋入路具有术野宽敞,暴露好,便于直视下操作等优点,可为翼腭窝及颞下窝原发恶性肿瘤整块切除提供新的解决方案。

Five patients with primary malignancies in the pterygopalatine fossa (PPF) and infra temporal fossa (ITF) were enrolled in this retrospective study between January 2012 and January 2018. After malignancies proven by biopsy and evaluation with CT and MRI scan, all patients received modified maxillary swing (MMS) approach for extirpation of malignant tumors in the PPF and ITF under general anesthesia. En bloc resection with wide surgical margins was successfully performed in all cases. Negative margins were observed in 4 cases and positive margins were found in one patient with adenoid cystic carcinoma who received postoperative radiotherapy. The most common complication was facial numbness. During the follow-up period (range 12 to 57 months), one patient suffered from recurrence while others did not. The advantages of MMS include wide surgical field, full exposure and easy manipulation. The MMS approach is expected to become an standard method for monobloc resection of malignancies in the PPF and ITF.