内镜下经口入路保留扁桃体茎突截短术疗效分析

目的 探讨经口入路内镜辅助下保留扁桃体茎突截短术的手术方法及临床疗效。 方法 回顾性分析36例(65侧)茎突综合征患者的临床资料,分析其主诉、病程、误诊情况、茎突长度、扁桃体肿大程度、手术时间、出血量、术后效果,记录患者手术前后的症状改善情况。 结果 36例患者中单侧茎突过长7例,双侧茎突过长29例,共65侧茎突。其中主诉为咽异物感27例,颈肩部疼痛不适12例,咽痛及吞咽痛11例,咽干、咳嗽7例,耳部疼痛3例,面部疼痛1例。病程为20 d~3年不等,平均10个月。被误诊为咽炎20例、胃食管返流4例、甲状腺疾病2例、颈椎病1例、上呼吸道感染1例,误诊率为77.8%。36例患者中扁桃体无肿大14例、Ⅰ度肿大20例、Ⅱ度肿大2例,均无慢性扁桃体炎及扁桃体肿物病史。术前茎突长度为(4.38±0.78)cm,其中最长的为7.89 cm,截短茎突的长度为(2.09±0.93)cm。手术时间(67.08±28.4)min,出血量(8.42±5.58)mL。其中6例患者7侧茎突因位置较深或分离困难行骨折外移。术后随访3个月以上,其中症状消失者27例,症状减轻者4例,症状无变化者4例,失访1例。 结论 经口入路内镜下保留扁桃体茎突截短术保留了正常的扁桃体,手术创伤小、术后疼痛较轻、恢复快、出血少、手术效果好,是治疗茎突综合征有效、安全、微创的手术方式。     

茎突综合征30例手术治疗临床分析

目的 探讨茎突综合征不同手术治疗方法的优势.方法 对30例茎突综合征采用不同的手术方法,其中20例扁桃体窝触诊可扪及硬性隆起者,采用切除扁桃体口内径路切除;3例舌腭弓触诊可扪及硬性隆起者,采用保留扁桃体口内径路切除术;7例咽部触诊未触及硬性隆起者,采用颈外径路切除术.结果 术后随访半年,26例咽部异物感、咽部疼痛感、耳痛、颈部下颌角部位疼痛症状消失,4例症状较术前明显减轻但未消失,无1例发生咽旁间隙感染、咽旁血肿及面神经麻痹等并发症.结论 手术截短是目前治疗茎突综合征的主要手段,临床工作中要根据茎突的长度、角度,咽部暴露情况等选择不同的手术径路,以达到最好的治疗效果.     

以头颈部疼痛为首发症状的茎突综合征分析

目的　探讨茎突综合征患者的临床表现、手术方式及术后效果,增强耳鼻咽喉科医师对该疾病的认识。方法　回顾性分析我科2012年12月～2017年1月收治的24例以头颈部疼痛为首发症状的茎突综合征患者的手术方式,并使用视觉模拟评分法（visual analogue scale,VAS）评估患者术后效果。结果　首发症状表现为咽痛14例,颈部胀痛5例,耳痛4例,颌面部疼痛1例。茎突CT三维重建示24例患者患侧茎突长度均＞30 mm。全部患者扁桃体窝触痛阳性。18例患者经颈外入路茎突截短术,6例患者经口扁桃体切除后行茎突截短术。术后随访3～20个月,21例症状缓解,3例症状较前无改善,有效率87.5%。VAS评分术前与术后比较差异有统计学意义（t =10.112,P <0.05）。结论　以头颈部疼痛就诊的茎突综合征患者易被误诊为咽炎、外耳道炎、淋巴结炎等疾病,扁桃体窝触诊是重要的辅助手法,茎突CT三维重建具有确诊价值。诊断明确者可考虑行茎突截短术,术后效果较满意。     

94例茎突综合征临床特点及诊疗思考

目的　根据94例茎突综合征患者的临床症状、专科查体以及影像学检查判断其临床特点和术后疗效。方法  对2010年1月～2019年1月间94例茎突综合征病例回顾性分析,通过颈外进路茎突截短术、扁桃体切除术+茎突截短术、保留扁桃体茎突截短术三种手术方式,分析术后疗效。结果　94例患者茎突截去长度为25～61 mm,平均33 mm。术后随访3～36个月,平均15个月,治愈45例（48%）,有效31例（33%）,无效18例（19%）,应用SPSS 19.0软件行秩和检验,三种手术效果无统计学差异（H =0.521,P >0.05）。其中20例行颈外进路茎突截短术,45例行扁桃体切除术+茎突截短术,29例行保留扁桃体茎突截短术。结论　手术为目前治疗茎突综合征有效方法,口内及颈外进路疗效无明显差异,应选择个体化的手术方案。     

经颌下径路治疗茎突综合征

报告30例(35侧)茎突综合征经颌下径路茎突截短术。其中茎突舌骨韧带骨化2例,茎突骨折1例。术前被误诊为牙痛而多次拔牙1例,X 线照片漏诊1例。经颌下径路术前茎突长3～7.5cm,平均右4.13cm,左4.38cm;手术截除平均长度右2.13cm,左2.26cm;术后存留平均长度右2.0cm,左2.12cm。术后经2月至6年(平均2年)随访,显效65.7%(23/35),好转28.6%(10/35),无效5.7%(2/35)。经咽径路茎突截短3例,其中1例术后发生颈深部出血和血肿。认为:经颌下径路茎突截短具有简便、安全。较咽径路更易暴露和截短,可作为茎突截短手术的首选;在临床上注意不要忽略茎突综合征的诊断,同时又要注意对茎突过长者要排除精神性咽痛的可能,以避免误行茎突截短术。     

茎突综合症25例临床分析

目的总结分析茎突综合症的临床特点、治疗及疗效。方法回顾分析1986年1月~2004年12月我院收治的25例茎突综合症病人的临床资料、治疗及疗效。结果本组病例中单侧发病者10例,双侧者15例;咽痛前来就诊者16例,单纯咽异物感者6例,耳痛、头痛及颈部痛者各1例。所有病人均行口内径路茎突截短术。术后随访6个月以上,其中症状消失者18例(72%),症状减轻者3例(12%),症状无改善者4例(16%)。结论完整的病史、临床检查及影像学检查有助于茎突综合症的诊断。口内径路行茎突截短术是治疗该病的有效方法。     

经口径路的茎突截短术治疗茎突综合征的临床观察

目的 分析对茎突综合征(Styloid process syndrome)患者,行经口径路茎突截短术治疗的价值。方法 收集本院于2018年10月—2021年9月,诊治的茎突综合征患者90例,以回顾性分析的形式,记录90例患者,实施经口径路茎突截短术治疗后的恢复情况。结果 90例患者手术均取得成功,手术后均未发生出血,咽喉旁间隙感染的情况。对所有患者开展为期半年的随访,其中有1例出现茎突中断的情况,末端骨化,中间纤维连接;其中90例患者的暴露满意度、截短长度、出血量、术后出血率、术后半年痊愈率以及术后半年有效率分别为:39例(86.67%)、(14.30±9.19)mm、(6.48±0.02)mL、0例(0.00%)、30例(66.67%)、42例(93.33%)。结论 目前对茎突综合征患者多行茎突截短术治疗,而经颈外进路和经口进路均可达到一定效果,因此临床中可根据患者茎突区域的差异,选择手术形式,从而达到治疗目的。     

外科治疗茎突异常的疗效分析

目的探讨茎突异常与咽部异常感觉的关系及手术疗效。方法对104例茎突异常的患者进行了茎突截短手术，回顾性分析手术前后的临床资料。结果104例引起咽部异物感、咽痛等感觉的茎突异常，经手术治疗后74例（71．2％）的患者症状消失，13例（12．5％）的患者症状减轻，无效的患者17例（16．3％），有效率为83．7％（87／104）。X线检查显示茎突舌骨韧带骨化的5例症状消失，而茎突骨不连的8例中6例症状消失，2例无效。颈外进路手术时1例钳夹止血时误钳面神经，造成面神经麻痹，经过4个月保守治疗痊愈；1例发生手术时出血，止血不成功而行颈外动脉结扎术。口内进路手术的患者，1例手术后5h发生创面出血，重新行创面缝扎止血。结论茎突异常并不全部引起咽部异常感觉，对于茎突异常和咽部异常感觉的患者应该仔细检查，综合分析。如需手术治疗应提倡口内进路，注意防止并发症。     

茎突综合征72例分析

目的:探讨茎突综合征的正确诊断方法。方法:对疑有下颌角区异物感、咽部疼痛感、牵拉感、扁桃体术后伤口未愈合感等患者行茎突CT扫描及CT三维重建,确诊为茎突过长263例,其中72例行扁桃体切除加茎突截短术(59例行茎突截短术,13例行梳理术)。结果:术后随访,72例患者术前症状全部消失。结论:CT扫描及三维重建对诊断茎突过长综合征准确、可靠。     

经扁桃体前外侧进路内镜辅助下茎突截短术15例

目的 探讨经扁桃体前外侧进路内镜辅助下茎突截短术的方法及疗效。方法 茎突综合征患者15例, 单侧发病者 10 例, 双侧者 5 例, 均行经扁桃体前外侧进路内镜辅助下茎突截短术。结果 随访3～12个月, 治愈11例15侧, 显效3例4侧。结论 经扁桃体前外侧进路内镜辅助下茎突截短术, 具有经口进路的优点, 术中能清楚辨别周围的血管、肌肉、神经, 可以避免切除扁桃体后的并发症。本组患者疗效较好, 未发生严重不良反应。     

Elongated styloid process syndrome: intraoral versus external approach for styloid surgery

Elongated styloid process is a source of craniofacial and cervical pain. This condition is characterized by a dull, nagging, pharyngeal pain and a palpatory finding in the tonsillar fossa. Radiologic demonstration of styloid elongation is readily made in most instances. The incidence and pathogenesis of the styloid syndrome are discussed and the differential diagnosis detailed. The only effective treatment is surgical shortening of the styloid process. Eight patients undergoing surgery for elongated styloids are reported and the intraoral and external surgical approaches are presented. The external cervical approach is preferred since surgical visualization is optimal and the risk of deep cervical infection is minimal.     

The syndrome of elongated styloid process

Symptom-complex associated with the elongated styloid process is more common than generally thought. The exact etiology of this syndrome has not yet been fully understood. The present article is a review of the symptoms, physical signs, theories of causation, diagnosis and treatment of this condition. During the 20 years period from 1975 to 1995, 35 symptomatic patients with the established diagnosis of elongated styloid process were managed. Their diagnosis were confirmed by clinical and radiological examinations. Surgical shortening of the elongated processes were done by intraoral transtonsillar approach under general anaesthesia. Twenty were bilateral and 15 were unilateral elongations. Eighteen were males and seventeen were females. Largest distribution of patients in age was seen in the fifth decade of life. Pain in the throat was most frequently encountered as the presenting complaint. A total of 31 patients obtained complete symptomatic relief within 6 months following operation. In four patients there were either incomplete relief or recurrence of symptoms after operations. Elongated styloid process may be one of the causes annoying maxillofacial or craniocervical pain. It requires thorough clinical examination of the head and neck, and should be confirmed radiologically. Occasionally multidisciplinary cooperation may be needed to come to a diagnosis. Surgical shortening of the elongated process is the only way to give symptomatic relief to the patient. Further research is needed to understand the aetiogenesis of this condition.     

Surgical management of elongated styloid process: intraoral or transcervical?

The purpose of this study is to compare the results of surgical approaches in management of elongated styloid process. Eight patients with Eagle’s syndrome due to elongated styloid process were included in this study. All necessary preoperative diagnostic work-ups were done and four of them were operated transorally and four were operated extraorally. Preoperative and postoperative symptoms and postoperative patient satisfaction were investigated. No early or late postoperative complications were encountered in transoral group. One of the patients who was operated transcervically experienced a transient weakness in the marginal mandibular branch of facial nerve which resolved spontaneously within 2 weeks. Complete remission of symptoms was achieved in seven patients at the final follow-up, only one of the patients, who was operated intraorally, had partial remission. Only one of the patients who had unilateral excision of elongated styloid process transcervically complained about the permanent scar. Transoral approach is a safe surgical alternative achieving adequate treatment. The advantages of intraoral approach include less surgical travma, less surgical time and lack of servical scar, with similar outcomes when compared with transcervical approach.     

Transcervical resection of the styloid process in Eagle syndrome

We conducted a retrospective study to determine the treatment outcomes of 6 patients who had either unilateral or bilateral elongated styloid processes and symptoms consistent with Eagle syndrome. Five of these patients had undergone transcervical resection of the styloid process, with relief of symptoms over the follow-up period (mean: 8 mo). Two of the 5 patients experienced a transient weakness in the marginal mandibular nerve, and both recovered completely. The transcervical surgical approach to resection in patients with elongated styloid processes and Eagle syndrome appears to be safe and effective, although the risk for transient marginal mandibular nerve weakness is notable.     

A case of bilaterally elongated styloid processes

Elongated styloid process gives a complex of symptoms described by Eagle such as unilateral craniofacial and cervical pain, recurrent throat pain, dysphagia and foreign body sensation. Symptoms might be similar to those caused by calcified stylohyoid ligament. Diagnosis of the elongated styloid process is based on the palpation of the tonsillar area and should be confirmed radiologically. Surgical shortening of the elongated process is the only way to give symptomatic relief to the patient. The authors present a surgically treated case of bilaterally elongated styloid processes and unilateral symptoms.     

扁桃体切除术后茎突综合征7例

目的 探讨扁桃体切除术后出现茎突综合征的原因及茎突切除术的实施疗效。方法对 7例扁桃体切除术后茎突综合征患者行茎突切除术,并对疗效进行临床分析。结果 行单侧茎突切除术治疗6例,行双侧茎突切除术治疗1例,术后随访3个月～3年,其中症状完全消失者5例,症状明显缓解者2例。结论 扁桃体切除术后出现茎突综合征可能与局部瘢痕形成牵拉有关,手术行茎突切除是有效的治疗手段。