改良颈腮腺入路切除咽旁间隙高位良性肿瘤

Modified cervical-parotid approach in the resection of upper benign tumors in the parapharyngeal space

目的探讨改良颈腮腺入路在高位咽旁间隙良性肿瘤手术中的应用疗效。方法7例咽旁间隙良性肿瘤患者,术前影像学检查提示为高位、肿瘤巨大、哑铃型且边界欠清,采用改良颈腮腺入路术式,解剖辨认面神经总干及颞面干后,于外耳道软骨前方、腮腺的后缘以及颞面干的上方间隙向深部分离至肿瘤上极,剥离子分离并下压肿瘤与下方常规颈部自下而上肿瘤游离会师后,从颌下区取出肿瘤。腮腺浅叶不切除,面神经分支不做过多解剖。结果所有患者均一次性完整切除肿瘤;术后病理示多形性腺瘤6例,神经鞘瘤1例;术中出血均少于300 mL;1例患者出现术后同侧眼睑轻度闭合障碍,两周后完全正常;所有患者面容美学保存理想。结论对于高位咽旁间隙良性肿瘤采用改良颈腮腺入路术式,不仅可以安全完整地切除肿瘤,同时由于减少了面神经及腮腺浅叶的处置,术后相关神经并发症及腮腺区凹陷性改变的发生率下降。

Objective To investigate the efficacy of modified cervical-parotid approach in resection of upper benign tumors in the parapharyngeal space.Methods A total of 7 patients were enrolled.Preoperative imaging showed big-sized,dumbbell-shaped tumors with unclear boundary.The modified cervical-parotid approach was adopted.After the main trunk and temporal branch of the facial nerves were identified,the upper part of the tumors was separated through the anterior cartilage of the external auditory canal,the posterior margin of parotid gland and the upper part of temporal branch.The tumors were then isolated and removed from the submaxillary region.During the procedure,the superficial lobe of the parotid gland was preserved,and only the necessary facial nerve branches were dissected.Results All tumors were completely removed in one stage operation.Postoperative pathology showed pleomorphic adenoma in 6 cases and schwannoma in 1 case.The hemorrhage volume was less than 300 mL.Mild peripheral facial paralysis occurred in 1 patient,who returned normal 14 days later.All patients had satisfactory cosmetic outcomes.Conclusion The modified cervical-parotid approach can remove the tumors safely and completely,reduce the exposure of facial nerves and superficial lobe of the parotid gland,and reduce the incidence of postoperative neuropathic complications and parotid pitting changes.