切除翼上颌及颅中窝底肿瘤的一个新手术进路(5例报告)

A NEW SURGICAL APPROACH TO EXTENSIVE TUMORS IN THE PTERYGOMAXILLARY FOSSA AND THE MIDDLE SKULL BASE: REPORT OF 5 CASES

目的 介绍切除翼上颌及颅中窝底肿瘤的一个新手术进路。方法 从上唇红唇向上达患侧鼻孔底 ,然后向外绕鼻翼向上达内眦 ,向外达耳屏前向上作半冠状切开。向下及向中线在骨膜下分别翻转颊瓣及头皮瓣。截除上颌骨、眶下及额颞颅底之颅骨后 ,肿瘤完全暴露 ;摘除肿瘤后 ,用微型夹板固定骨块。分层缝合复回之组织瓣。结果 可获得从对侧咽鼓管到同侧膝状神经节 ,包括鼻咽、斜坡、蝶窦、翼静脉丛及颞下窝和眶上裂在内的良好暴露。用本进路对 5例患者进行了治疗 ,全部一期愈合。结论 本进路对包括鼻咽、斜坡、眶上裂、颞下窝及翼腭窝在内的肿瘤病变特别有用。

Objective The article describes a new surgical approach to extensive tumors in the pterygomaxillary fossa and the middle skull base. Methods The lip split incision begins at the vermilion border and continues along the nasal ala and the lateral nose. It turns horizontally at the inner canthus, which transects, to the lateral canthus, at which point it exits to meet the vertical coronal / preauricular incision. The level of the hard palate after the elevation of the maxillary periosteum and the masseteric fascia in a downward fashion. The frontotemporal scalp is reflected toward the midline after completion of the coronal and transtemporal incision and an appropriate undermining. Craniofacial skeleton is exposed from the middline. After osteotomies of the orbitomaxillary skeleton and an oblique subperiosteal osteotomy over the angle of the mandible are completed, a frontotemporal craniotomy is performed at this time, identifying foramina spinosum, ovale and rotundum, as we as the superior orbital fissure. The tumor is exposed in the surgical field, after the tumor resected, the orbito-maxillary skeleton, removed during the approach phase, is replaced and affixed by miniplates. The external soft tissues, including the skin, are then reapproximated along the preoperative markings. Results Surgical field obtained at the skull base can extend from the contralateral eustachian tube to ipsilateral geniculate ganglion. It includes the nasopharynx, clivus, sphenoid, and cavernous sinus, pterygopalatine fossa, as well as the entire infratemporal fossa and superior orbital fissure. This approach was used in 5 patients. All patients healed primaryly. Conclusion This technique is especially useful to tumors in the nasopharynx, clivus, superior orbital fissure-cavernous sinus, infratemporal, and pterygopalatine fossae.