内镜辅助耳前颞下窝入路颞下窝良性肿瘤切除术

Resection of infratemporal fossa benign tumors via endoscopic preauricular infratemporal fossa approach

目的探讨内镜辅助经耳前颞下窝入路切除颞下窝良性肿瘤的可行性及疗效。方法采用内镜辅助经耳前颞下窝入路切除颞下窝良性肿瘤5例,男1例,女4例;年龄41~59岁,平均51岁。主要症状是咀嚼不适感4例,患侧头痛3例,患侧听力下降2例。主要体征为患侧颞颧部膨隆3例,其余2例无明显阳性体征。结果手术均在1.5~3.0 h内顺利完成,肿瘤完全切除。患者术后感觉患侧咀嚼无力、闭合力稍差、张口受限、术区肿胀,约2个月后基本正常。随访6~26个月,平均18个月,未发生面瘫、无颞下颌关节错位咬合、无慢性疼痛等并发症,其中1例术后12个月,仍感觉患侧下颌部麻木。切口均甲级愈合。术后病理2例为巨细胞修复性肉芽肿,2例为骨巨细胞瘤,1例为磷酸盐尿性间叶组织肿瘤。所有患者随访至今均无复发。结论内镜辅助经耳前颞下窝入路可以彻底切除翼外板、翼外肌下头外侧区域颞下窝上部关节区附近的一些良性肿瘤,是安全、有效、微创的,值得临床推广应用。

Objective To investigate the feasibility and curative effect of resection of infratemporal fossa benign tumors via endoscopic preauricular infratemporal fossa approach.Methods The surgical records and medical charts of 1 male and 4 females(age ranged from 41 to 59 years old with a mean age of 51)diagnosed with infratemporal fossa tumors and operated via endoscopic preauricular infratemporal fossa approach in our hospital between Feb 2017 and Sept 2019 were reviewed.As for the symptoms,4 cases complained of chewing discomfort,3 cases complained of headache,2 cases complained of decreased hearing.Physical examinations detected bulging temporal zygomatic area of the affected side in 3 patients.Results Complete removal of the tumor was achieved in all the 5 cases with the operative time from 1.5h to 3.0h.Postoperatively,all patients felt temporary weak mastication,slightly less closing force and less swelling on the affected side,which returned to normal about 2 months later.Postoperative numbness in the lower jaw of the affected side was observed in one case through 12 months after the operation.All incisions healed at grade A.There was no evidence of permanent complications and local recurrence through a median follow-up time of 18 months(ranged from 6 to 26 months).Postoperative pathology revealed giant cell reparative granulomas in 2 cases,giant cell tumor of bone in 2,and phosphaturic mesenchymal tumor in one.Conclusion With advantages of good safety and effectiveness as well as minimal invasion,the endoscopic preauricular infratemporal fossa approach is worth promoting in complete removal of some select group of benign tumors involving the superior of infratemporal fossa near temporomandibular joint.