内镜下经鼻和经口颞下窝良性肿瘤手术36例报告

Clinical practice of infratemporal fossa benign tumor endoscopic transnasal/oral surgery in 36 patients

目的根据内镜下经鼻和经口进行颞下窝肿瘤手术的特点进行颞下窝分区,探索内镜下经鼻和经口颞下窝肿瘤切除手术的径路选择,并分析其优缺点。方法回顾分析36例内镜下经鼻和经口成功切除颞下窝良性肿瘤患者资料,分析肿瘤在颞下窝区域定位特点,对颞下窝进行系统定位分区研究。总结内镜下经鼻和经口手术径路的选择原则及其优缺点。结果将颞下窝区域分为ABC区,A区为上颌窦后外侧脂肪区;B区进一步分为B1(上颌窦底壁平面上方,茎突前方),B2(上颌窦底壁平面下方,茎突前方),B3区(茎突后方至椎前);C区为咽后及咽鼓管区。根据肿瘤主体在颞下窝分区中的定位特点,选择经鼻和经口入路。肿瘤均获完全切除,随访期间无肿瘤复发。少数患者出现局部感觉功能下降,随访期间均有所恢复。结论根据内镜下口鼻手术入路特点命名的颞下窝区域解剖分区,简便实用,可有效指导颞下窝区域手术,有临床推广运用价值。

Objective According to the characteristics of endoscopic transnasal and transoral surgery for infratemporal fossa tumors,we divided and named subzones of the infratemporal fossa,to explore the approaches of endoscopic transnasal and transoral surgery for infratemporal fossa tumors,and to analyze their advantages and disadvantages.Methods We retrospectively analyzed the clinical data of 36 patients with benign tumors of infratemporal fossa successfully resected through nose or mouth under endoscope,summarized and analyzed the localization characteristics of these tumors in infratemporal fossa,and made a subzone naming rule of infratemporal fossa.We also summarized the selection principles,advantages and disadvantages of endoscopic transnasal and transoral surgical approaches.Results The infratemporal fossa area is divided into ABC area.Area A is the fat pad area posterolateral of maxillary sinus.Area B is further divided into B1(above the plane of maxillary sinus floor,anterior styloid process),B2(below the plane of maxillary sinus floor,anterior styloid process),and B3(posterior styloid process to anterior vertebra);Area C is retropharyngeal and eustachian tube area.The location of the tumor in the infratemporal fossa determines the choice of transnasal and transoral approaches.All tumors were completely removed,and no tumor recurred during the follow-up.A few patients had temporary local sensory function decline,and recovered during the follow-up.Conclusion The infratemporal fossa region naming rule according to the characteristics of endoscopic transoral and transnasal surgery approach is simple and practical,which can effectively guide the operation of the infratemporal fossa region and has clinical application value.