21例咽旁颞下区肿瘤手术入路选择及临床疗效分析

Surgical approach selection and clinical effect analysis of 21 cases with parapharyngeal subtemporal tumors

目的探讨位于咽旁颞下区肿瘤的临床表现及手术入路选择,总结治疗效果,为临床提供参考。方法回顾性分析自2016年11月至2022年6月于北部战区总医院口腔颌面外科接受手术治疗的21例咽旁颞下区肿瘤患者的临床资料,包括影像学检查、组织学检查,分别应用经口、经颌下、经耳前-颌下、经半冠状-耳前以及半冠状-耳前-颌下5种切口入路方式切除肿瘤。结果21例患者均完整切除肿瘤。其中,17例为良性肿瘤,术后无复发;4例为恶性肿瘤,1例复发,其余未见复发及转移。术后随访时间为6~60个月,术后病理显示共有13种病理类型,最常见的为多形性腺瘤(4例)和神经鞘瘤(3例)。结论外科手术切除是治疗咽旁颞下区肿瘤的首选方法,术前的增强CT及MRI检查可以明确肿瘤的位置及大小,对性质判断有一定帮助,可以为手术方案选择提供参考。对于病变广泛,尤其侵犯颅底、颅内及下颌升支的恶性肿瘤,侧方入路联合下颌骨劈开或颧弓截断可显露更直观,切除更彻底。

Objective To analyze the clinical characters and surgical approach selection of tumors located in the parapharyngeal subtemporal region.Method A total of 21 patients with parapharyngeal subtemporal tumors who received surgical treatment from November 2016 to June 2022 were included for retrospectively analyzed,including imaging examination and histology examination.Five incision approaches were used to remove tumors by oral,submaxillary,preauricular-submaxillary,semi-coronal-preauricular,and semi-coronal-preauricular-submaxillary approach.Results The tumors were completely resected in 21 patients,and the tumors were benign in 17 patients without recurrence.4 cases of malignant tumor,1 case recurrence,the rest no recurrence and metastasis.With a 6 to 60 months follow-up.The postoperative pathology showed a total of 13 pathological types,the most common of which were pleomorphic adenoma(4 cases)and schwannoma(3 cases).Conclusion Surgical resection is the preferred method for the treatment of parapharyngeal subtemporal tumors.Preoperative enhanced CT and MRI examination can clarify the location and size of the tumors,which is helpful for the determination of the nature,and can provide reference for the surgical plan.For malignant tumors with extensive lesions,especially those involving the skull base,intracranial and ascending mandibular rami,the semi-corona-preauricularsubmaxillary approach combined with mandibular splitting or zygomatic arch amputation can be more intuitive and complete.