【作者】 何三纲； 李祖兵； 赵吉宏； 张文峰； 刘冰； 东耀峻； 赵怡芳；

【Author】 San-gang He, Zu-bing Li, Ji-hong Zhao, Wen-feng Zhang, Bin Liu; Yao-jun Dong, Yi-fang Zhao Department of Oral and Maxillofacial Surgery, School of Stomatology, Wuhan University, P. R. China.

【机构】 武汉大学口腔医学院口腔颌面外科；

【摘要】 <正>目的:根据咽旁间隙良性肿瘤的临床表现特征和咽旁间隙的解剖特点,为减少因截骨带来的并发症, 设计旋转法分离摘除原发于咽旁间隙的良性肿瘤,籍以减轻手术创伤,提高咽旁间隙肿瘤的治疗效果和减少术后并发症。材料和方法:本院收治的6例咽旁间隙良性肿瘤患者接受该法的手术治疗。术前患者分别接受了CT和MRI的检查;手术经颌后-颌下径路、经腮腺径路、或经口腔径路;在分离咽旁间隙的良性肿瘤时采用旋转法使瘤体经手术切口离体,顺利摘除肿瘤。结果:本组病例资料中男性2例,女性4例,年龄最大34岁-63岁;6例中4例经腮腺-颌下径路,2例经颌后-颌下径路,其中2例辅以口腔径路,以利分离肿瘤。肿瘤直径为4-9cm。术后病理结果为:腮腺多形性腺瘤4例,神经纤维瘤1更多还原

【Abstract】 OBJECTIVE: In order to avoid the functional and cosmetic impact of osteotomy, the authors describe a new method for resecting the benign tumor in the parapharyngeal space (PPS) according to the anatomical characteristics of the PPS and the clinical manifestations of the tumor in the PPS. PATIENTS and METHODS: 6 patients with benign tumors of the PPS were received preoperative evaluation with CT and/or MRI without or with angiography if necessary. Surgical resection was performed through the transparotid approach, transcervical approach, or with additional intraoral approach. The neoplasms were completely resected by dissection of the tumor, rotation and removal of the tumor. Intra-oral incision was done to help the rotation in case of large benign tumor.RESULTS: In this study, 2 were male and 4 were female. The youngest patient was 34, the oldest 63 years of age (mean: 49), All the tumors were resected completely. 4 cases through the transparotid approach, 2 cases through rranscervical approach, 2 of them with additional intraoral approach. Six patients with giant lesions in these areas (with maximum tumor diameter >9 cm) were treated via this method. Postoperative pathologic findings showed that 4 cases were salivary gland tumors, other are neurogenic tumor and lipoma. Complications were rare; the most common was transient facial nerve paralysis. One to two years of follow-up examinations and CT check-up did not reveal any traces of recurrence postoperatively.CONCLUSIONS: (1) Benign tumors in both prestyloid and poststyloid PPS can be resected through a transcervical approach, with dissection and rotation of the tumor, avoiding unnecessary surgery for mandibular ramus osteotomy. This method provides good exposure of the parapharyngeal space; it facilitates resection of the tumor en bloc. It provides operative safety and minimal morbidity. (2) CT and/or magnetic resonance studies should be routinely obtained to evaluate tumors of the PPS, the relationship of the tumor to the great vessels should be clearly delineated by angiography. Preoperative imaging and careful preparation are important and likely to improve outcome. (3) It is essentially useful for proper choice of surgical approach and dissection method. Benign parapharyngeal space tumors can be removed surgically by using rotation method. There were no major postoperative neurological or vascular complications. On subsequent follow up, there were no clinical or radiological signs of residual or recurrent tumor.更多还原