改良面部正中翻揭术在鼻腔鼻窦肿瘤手术中的应用探讨

Study of the modified midfacial degloving in surgery of sinonasal tumors

目的 :探讨有效的治疗鼻腔、鼻窦肿瘤手术方法。方法 :利用改良面部正中翻揭术治疗 2 4例鼻腔、鼻窦肿瘤的病人 ,其中 6例结合内镜技术。该术式将传统正中翻揭术的鼻前庭环形切口改为鼻中隔的贯穿切开和鼻腔外侧壁的骨膜下切开。本组病例 ,筛窦骨瘤 2例 ,鼻中隔血管瘤 1例 ,鼻腔、筛窦血管瘤 3例 ,鼻腔、上颌窦血管瘤 3例 ,鼻腔筛窦内翻乳头状瘤 7例 ,鼻腔筛窦鳞癌 2例 ,鼻腔鳞癌 3例 ,上颌窦鳞癌 2例 ,复发性上颌窦鳞癌 1例。鼻腔筛窦内翻乳头状瘤和恶性肿瘤 ,皆未侵犯前筛窦、前颅底及眼眶。鼻腔筛窦内翻乳头状瘤和鳞癌术后皆行放疗。结果 :2 4例手术皆成功。该手术切口可变通 ,对鼻腔、鼻窦、鼻咽及前中颅底皆可充分暴露 ,结合内镜技术可减少术中创伤和术后并发症。患者对术后外形皆满意。无鼻前庭狭窄、鼻中隔穿孔、口鼻瘘管等 ;12例面部麻木术后 6个月均渐好转 ;5例溢泪皆行泪道冲洗后好转 ;1例复发性上颌窦癌病人再次手术后 3个月因肺部转移死亡 ;1例鼻腔筛窦内翻乳头状瘤术后 8个月复发。结论 :改良面部正中翻揭术是一种变通而实用处理鼻腔。

Objective: To study the effectively operative methods for treatment of sinonasal tumors.Methods:Twenty\|four patients with sinonasal tumors were performed by the modified midfacial degloving,six of which were combined with endoscope techniques.In our technique,the circumferential vestibular incisions of the standard midfacial degloving was modified to septal transection and bilateral nasal lateral osteotomies.There were 2 ostomas in the ethmoid sinuses,1 hemangioma of nasal septum,3 hemangiomas in the nasal cavities and ethmoid sinuses,2 hemangiomas in the nasal cavities and maxillary sinuses,7 inverted papillomas in the nasal cavities and ethmoid sinuses,3 squamous cell carcinomas in the nasal cavities,2 squamous cell carcinomas in nasal cavities and ethmiod,2 squamous cell carcinomas in maxillary sinuses,1 relapsing squamous cell carcinoma in maxillary sinus.According to CT results,anterior skull\|base and anterior ethmiod and orbit were not breached in all the malignant tumors and inverted papillomas.Postoperative irradiation for local control was given in squamous cell carcinomas and inverted papillomas.Results:All the tumors were removed completely by the modified midfacial degloving.All the patients were followed up from 18 months to 42 months.The modified midfacial degloving was a versatile and practical approach.It offered excellent exposure of the nasal cavities,paranasal sinus,nasopharynx and central skull\|base and avoided midfacial incisions and scars.If the approach was combined with endoscope techniques,the intraoperative lesions and the postoperative complications were greatly decreased.The blood losing was dramatically reduced in the procedure and no nasal septal perforation,vestibular stenosis and oro\|anfral fistala was found post\|operatively.Epiphoras were seen in the enlarged excision of nasal lateral wall and improved by irrigation of lacrimal passages.The immediate postoperative paraesthesia of the overlying skin was temporary.Conclusions:The modified midfacial degloving was proved to be an extremely valuable technique in surgery of sinonasal tumors,displaying excellent cosmetic and functional results with minimal complications.It should be promoted.