美容切口在腮腺手术中的运用

目的：尝试改良腮腺手术切口，以尽最大可能使切口瘢痕隐蔽。方法：对16例腮腺良性肿瘤患者（其中多形性腺瘤10例、腺淋巴瘤6例）采用耳前切口向下至耳垂后向后延伸至发际并沿发际边缘延伸的改良切口入路行腮腺区肿瘤及浅叶切除、面神经解剖术，术中尽量保留耳大神经，并随访1年观察术后切口隐蔽情况和手术预后。结果：所有患者均达到Ⅰ期愈合，无涎瘘和感染发生。术中术野暴露清晰，操作方便。术后2例患者出现暂时性面瘫，分别于1和2个月后恢复正常。其余患者未出现面神经损伤症状。16例患者中12例出现术后耳垂麻木，除耳大神经被切断者4例耳垂麻木症状无改善外其余8例均于术后3个月后恢复感觉。另外4例患者因手术切口为颞部和耳前切口未切至耳大神经区术后无耳垂麻木症状。患者对术后切口美观程度满意。术后随访1年无1例患者出现复发。结论：改良切口行腮腺区良性肿瘤及浅叶切除、面神经解剖术，术中术野暴露清晰，操作方便，不易损伤面神经，切口隐蔽，具有临床应用价值。     

腮腺良性肿瘤的美容功能性术式临床应用

目的：探讨通过改良术式提高腮腺良性肿瘤手术的美容效果和功能的恢复。方法：手术治疗腮腺良性肿瘤47例,术式中对切口位置、SMAS腮腺筋膜瓣和胸锁乳突肌瓣的应用、保留导管的腮腺区域性切除、面神经及耳大神经的保护、腮腺残端及创区的处理等方面作了相应改良。并对术后美容效果和功能的恢复进行3～18个月的随访检查。结果：术后颌面部切口隐蔽瘢痕不明显,腮腺区外形良好,无凹陷畸形,无涎瘘和Frey氏综合征,耳垂和耳廓背部皮肤感觉功能及腮腺分泌功能基本正常。患者对面容和功能的恢复均较满意,未见肿瘤复发。结论：改良的腮腺肿瘤术式提高了手术的整体质量,取得了较好的美学和功能效果。     

耳屏周小切口在腮腺良性肿瘤切除中的应用

【摘要】目的评估耳屏周小切口在腮腺良性肿瘤切除术中应用的临床价值。方法30例腮腺良性肿瘤患者,应用耳屏周小切口行浅叶部分切除、保留面神经和耳大神经的腮腺良性肿瘤切除术。术后随访3～24个月,观察耳屏周小切口的美观度及临床疗效。结果所有患者均临床Ⅰ期愈合,术后腮腺功能良好,无涎瘘发生。随访,患者双侧外形对称,无凹陷等畸形,手术切口隐蔽,患者对耳周切口美学效果满意。本研究中出现术后暂时性面瘫患者2例,皮质激素并配合神经营养药物综合治疗后3个月均恢复正常;出现术后耳垂麻木不适患者4例,手术后3～10个月均逐渐恢复。本研究中所有患者均未出现味觉出汗综合征,无肿瘤复发。结论耳屏周小切口隐蔽、瘢痕小、并发症低,术后美容效果理想。     

保留与切断锁骨上皮神经治疗锁骨骨折的比较

[目的]探讨保留与切断锁骨上皮神经治疗锁骨骨折的临床疗效。[方法]2014年1月~2015年12月收治66例锁骨骨折患者,其中男42例,女性24例,均行手术治疗;随机分成两组,保留组术中游离保留锁骨上皮神经,切断组采取切断锁骨上皮神经的传统手术方式,术后随访观察对比两组肩部及胸外上部感觉的差异性及满意度。[结果]36例保留组与30例切断组手术时间和术中出血量的比较差异无统计学意义(P0.05),术后第3 d,36例保留组患者中23例(63.88%)存在麻木,30例切断组患者均存在麻木(100%),麻木程度和麻木意识在保留组和切断组的比较差异有统计学意义(P0.001);术后有效随访35例,保留组14例,切断组21例。14例保留组的患者中3例(21.43%)存在麻木(P=0.019)。21例切断组的患者中有13例(61.90%)存在麻木。在穿戴肩带(衣服或背包)时意识到麻木两种手术方式的比较差异有统计学意义(P=0.042)。患者对术后带来的麻木感到厌烦,表示严重不满意。[结论]保留锁骨上皮神经治疗锁骨骨折,麻木程度明显减少,疗效确切,值得临床推广。     

腮腺良性肿瘤手术的美容设计

目的：探讨如何通过改良术式达到腮腺良性肿瘤手术的美学效果。方法：改良术式手术治疗腮腺良性肿瘤75例。术式中对以下方面作了相应改良：切口设计、耳大神经的保护、腮腺区域性切除、胸锁乳突肌瓣的应用、腮腺残端的处理等。随访观察该切口的美观程度以及临床疗效。结果：所有患者均达临床一期愈合,无涎瘘发生。13例患者术后出现暂时面瘫,3个月后恢复。所有患者术后均出现不同程度的耳垂麻木,于术后2个月恢复。患者对该切口的美观程度比较满意。结论：改良的腮腺肿瘤术式提高了手术的整体质量,克服了部分经典腮腺手术带来的美观方面的缺陷。     

改良腮腺良性肿瘤切除术的美学效果

目的：探讨改良功能性腮腺良性肿瘤切除术的临床效果和美学效果。方法：收集32例腮腺良性肿瘤病例,采用腮腺美容切口、保留耳大神经、腮腺区域性切除和SMAS筋膜填塞（或植入脱细胞真皮基质）等改良腮腺良性肿瘤切除术,随访6～24个月,通过问卷调查患者面部外形满意度、腮腺区味觉出汗症状和术区感觉恢复情况,临床检查和淀粉碘试验评价面部外形、面神经功能和Freys综合征。结果：术后切口均Ⅰ期甲级愈合,随访6～24个月,腮腺区外形良好,凹陷畸形不明显。28例面神经功能评价为House-Brackmann分级Ⅰ级,4例为II级;3例术侧耳垂麻木,术后3～8个月触觉、痛觉和温度觉逐渐恢复;1例出现Freys综合征;术后美容效果满意率100%。结论：应用改良腮腺良性肿瘤切除术尽可能保留了术后腮腺功能,有效减少了术后多种并发症的发生,获得了良好的美学效果。     

多功能保留在甲状腺癌颈淋巴结清扫术中的应用

目的探讨多功能保留在甲状腺癌颈淋巴结清扫术中的可行性及意义。方法回顾性分析我院2006年4月至2009年12月因甲状腺癌行甲状腺切除加Ⅱ~Ⅵ区多功能保留颈淋巴结清扫术61例,4例行双侧颈淋巴结清扫,共65例次。其中甲状腺乳头状癌54例,甲状腺滤泡状癌3例,甲状腺髓样癌4例。结果 61例中保留耳大神经60例次,枕小神经50例次,锁骨上皮神经59例次,颈横动、静脉48例次。术后患者随访0.5~4年,1例术后18个月复发,1例3年复发,59例无复发,术后患者均于3个月内耳廓感觉恢复,下颈部及肩部无麻木感,颈部外观无改变。结论多功能保留在甲状腺癌颈淋巴结清扫术中应用,既可达到根治肿瘤的目的,又能有效保留耳廓区、颈部、锁骨上区的感觉,具合理性、可行性。     

腮腺区肿物切除后面神经缺损的手术修复

目的 探讨腮腺癌、面神经肿物切除后面神经缺损修复方法的可行性,并对各种面神经缺损修复方法进行评价.方法 对腮腺恶性肿物侵袭面神经扩大切除及发生在面神经的神经源性肿物切除后面神经缺损的32例患者进行了神经移植修复.其中单纯采用耳大神经移植19例,神经长度1～2 cm;朐锁乳突肌携带耳大神经5例,修复腮腺恶性肿瘤扩大切除后骨面暴露的面神经缺损;携带筋膜面神经颈支修复下颌缘支缺损5例,携带筋膜面神经上颊支修复颧支缺损3例.所有手术均在双人双目手术显微镜下进行,用9-0及11-0无损伤缝合线吻合神经.结果 面神经恢复标准按照刘世勋面神经损伤修复评价标准进行评价.采用单纯耳大神经移植修复面神经缺损19例,术后恢复时间为6～18个月,恢复程度多数为部分功能恢复;胸锁乳突肌携带耳大神经移植修复面神经缺损5例,术后恢复时间为6～12个月,恢复效果比较理想;携带筋膜面神经颈支、上颊支修复下颌缘支、颧支缺损8例,术后恢复时间为6个月左右,恢复效果均比较理想.结论 几种神经移植修复面神经缺损,均是可行的.但采用面神经次要神经修复主要神经,修复效果比较理想.对于腮腺癌扩大切除后局部骨面外露者,采用胸锁乳突肌携带耳大神经移植修复是一种比较理想的修复方法.     

瘢痕性隐耳的手术修复

目的探讨瘢痕性隐耳的定义及其伴有部分或完全耳垂缺损的手术修复效果。方法采用局部皮瓣加全厚皮片分区移植法，分别完成耳廓与颅侧壁及乳突部粘连松解、颅耳角形成、耳轮重建、耳垂再造或重建手术，对26例33只瘢痕性隐耳进行矫正。结果所有皮瓣均100％成活，移植皮片95％以上存活；耳廓外形尚较满意，主要结构可辨，颅耳角基本恢复。术后随访3个月至1年．结果表明，耳廓外形保持良好，患者满意。结论针对瘢痕性隐耳的畸形特征，采取相应的手术方法，是矫正瘢痕性隐耳的有效手段。     

先天性小耳畸形的残耳组织在再造耳廓修整术中的应用

目的 总结先天性小耳畸形的残耳组织在再造耳廓修整手术中的应用.方法 2000年10月至2006年7月,对1 823例已完成自体肋软骨支架移植耳廓再造术的先天性小耳畸形患者,在再造耳廓修整手术中应用残耳组织形成残耳皮瓣,用以再造耳屏、对耳屏、耳轮脚和耳甲腔.或向上方旋转松解耳廓上极与颅侧壁的粘连;形成残耳软骨瓣转移至支架下方重塑颅耳角或转移至耳前皮下充填面部凹陷;通过皮下蒂转移耳前残存皮赘至再造后的耳垂用以丰满后者.结果 在1 823例患者中,再造耳廓修整术中应用残耳组织形成残耳皮瓣再造耳屏、对耳屏、耳甲腔1180例;形成残耳皮瓣向上方旋转松解耳廓上极与颅侧壁的粘连68例;应用残耳组织形成耳轮脚皮瓣或皮肤软骨复合组织瓣修复耳轮脚743例;形成残耳皮瓣丰满耳垂37例;形成残耳皮下组织软骨瓣95例,其中转移至耳软骨支架基底重塑颅耳角77例,转移至耳前皮下充填面部凹陷18例.上述组织瓣完全成活.无一例发生血运障碍.对273例患者进行远期随访,随访1～6年,平均2.5年.修整后的再造耳廓各微细结构清晰,与健侧更加接近,患者及家属均满意.结论 应用残耳组织可形成各种残耳组织瓣,进行再造耳廓的修整效果满意;残耳组织是再造耳廓修整手术中最好的材料来源,在耳廓再造手术中不能轻易切除,应尽量保留以备修整术时充分应用.     

Is it necessary to preserve the posterior branch of the great auricular nerve in parotidectomy?

OBJECTIVES: To evaluate the necessity of preserving the posterior branch of the great auricular nerve during parotidectomy. STUDY DESIGN AND SETTING: Forty-six patients undergoing parotidectomy were prospectively analyzed. Twenty-four patients had preservation of the posterior branch of the great auricular nerve; in the remaining 22 patients the nerve was sacrificed. A sensory index score was defined as the area involved multiplied by the intensity grade of sensory loss. Quality-of-life was evaluated with a questionnaire. RESULTS: The sensory index score was significantly higher in the sacrificed group as compared with the preserved group at both 1 week (41.87 vs 62.11) and 1 month (24.91 vs 46.11) after parotidectomy. The sensory deficit improved over time in both groups, and after 12 months only minimal sensory loss remained. Quality-of-life was not significantly different between the groups. CONCLUSIONS: Irrespective of preservation of the posterior branch of the great auricular nerve, sensory deficit improved over time. Therefore, preservation of the posterior branch of the great auricular nerve might not be necessary during parotidectomy.     

Sensation recovery improved by great auricular nerve preservation in parotidectomy: a prospective double-blind study

BACKGROUND: The great auricular nerve (GAN) is frequently sacrificed during parotidectomy and causes sensory disturbance of the auricle. Our study is to investigate whether GAN preservation can improve the sensory recovery. METHODS: Patients undergoing superficial or total conservative parotidectomy for benign tumours were recruited consecutively from November 1998 to September 2001. Different sensory methods (light touch, two-point discrimination and sharp pain) of the auricle were evaluated by a designated physiotherapist preoperatively as well as at 1, 3, 6 and 12 months postoperatively. The patients and the physiotherapist were blinded to the integrity of the GAN. Long-term subjective assessment was also carried out beyond 2 years postoperatively. RESULTS: A total of 21 patients were recruited for the study. GAN were preserved in 10 patients. The mean follow up was 16 months (12-42 months). There was no difference in sex distribution, type of operation and pathology of parotid tumour between the two groups. No postoperative mortality occurred and postoperative morbidity did not differ between the two groups. Patients with GAN preserved had significantly better light touch and sharp pain recovery at 1 year postoperatively. Subjective assessment of sensory dysfunction also favoured GAN preservation. CONCLUSION: Great auricular nerve preservation minimizes the postoperative sensory disturbance and should be considered whenever tumour clearance is not compromised.     

Adenoid cystic carcinoma of the parotid gland: Anastamosis of the facial nerve with the great auricular nerve after radical parotidectomy

Adenoid cystic carcinoma of the parotid gland is a rare and slowly growing, but highly malignant tumor. Surgical resection of a malignant parotid tumor should include resection of the facial nerve when the nerve is involved in the tumor. Facial nerve reconstruction is required after nerve resection. A 14 year-old female presented with complaints of painless enlargement of the right parotid gland and facial asymmetry. Physical examination revealed a firm mass in the region of the parotid gland as well as right facial paralysis. Biopsy obtained from the mass showed an adenoid cystic carcinoma of the parotid gland. A radical parotidectomy with a modified radical neck dissection was carried out. Grafting material for the facial reconstruction was harvested from the great auricular nerve. The proximal main trunk and each distal branch of the facial nerve were coapted with the greater auricular nerve. The patient received radiotherapy after surgery and was seen to achieve grade IV facial function one year after surgery. Thus, the great auricular nerve is appropriate grafting material for coaptation of each distal branch of the facial nerve.     

Randomized clinical trial comparing partial parotidectomy versus superficial or total parotidectomy

BACKGROUND: In recent decades the treatment of benign parotid tumours has shifted from superficial or total parotidectomy to partial parotidectomy. This study examined whether current surgical techniques improved functional outcomes after surgery for benign parotid tumours. METHODS: One hundred and one patients were assigned randomly to conventional (49 patients) or function-preserving (52) surgery. The latter consisted of modified facelift incision, greater auricular nerve preservation, partial parotidectomy and coverage with parotid fascia. RESULTS: The mean duration of operation was 0.7 h shorter and the overall complication rate significantly lower in the functional surgery group. In this group, more patients were satisfied with their scars and facial contours, the auricular nerve sensory recovery rate was high, and transient facial paralysis and Frey's syndrome were infrequent (12 and 6 per cent respectively). Stimulated salivary flow on the operated side decreased to 71.9 per cent after function-preserving surgery compared with 20.7 per cent after conventional operation. There was no tumour recurrence in either group during a mean follow-up of 48 months. CONCLUSION: Compared with conventional procedures, function-preserving surgery for benign parotid tumours improved cosmetic, sensory and salivary functions, and reduced the duration of surgery and operative morbidity.     

除皱美容切口在腮腺良性肿瘤手术中的应用

目的:探讨除皱美容切口在腮腺良性肿瘤手术中的临床疗效和美容效果。方法:腮腺良性肿瘤26例,采用美容切口、保留腮腺主导管的区域性切除,并对术后临床疗效和美容效果3~18个月的随访。结果:所有患者均达到I期愈合,无涎瘘和感染发生,术后切口隐蔽、瘢痕不明显,腮腺区外形良好,腮腺分泌功能基本正常。患者对面容和功能的恢复均较满意,肿瘤无复发。结论:应用除皱美容切口的腮腺良性肿瘤切除术既保证了手术的整体质量,又取得了较好的术后美学效果。     

Modified superficial parotidectomy: preserving both the great auricular nerve and the parotid gland fascia.

OBJECTIVE: To reduce the incidence of sensory deficits and Frey's syndrome by modifying the traditional superficial parotidectomy. STUDY DESIGN: After raising the skin flap, the parotid gland fascia (PGF) was elevated to form a posterior pedicle fascial flap and then was replaced after the gland removal. The great auricular nerve (GAN) that runs within the PGF was not separated, so both the GAN and the PGF were preserved. Before this modification, the GAN and PGF were examined anatomically. The complication rates in the modified and control groups were compared. RESULTS: 1) The GAN, which runs within the thick and pycnotic PGF, trifurcates into postauricular, preauricular and lobule branches. The modification could be carried out practically based on the anatomy study. 2) Long-term sensory deficit was encountered in 13.3% of the control group, but 0% in the modified one. Frey's syndrome was suffered by 66.7% and 16.7% cases in the control and modified group respectively. The incidence of other complications was not significantly different. CONCLUSION: Our modification is practical. It decreases the complications significantly. EBM rating: B-3b.     

皮肤扩张及自体肋软骨支架法全耳廓成形术矫正先天性小耳畸形

目的探讨耳后乳突区皮肤扩张及自体肋软骨支架法全耳廓成形术矫正先天性小耳畸形的临床效果。方法21例先天性小耳畸形患者,分3期进行手术治疗。Ⅰ期：患侧耳后乳突区皮下埋置50ml肾形扩张器,术后定期注水,扩张皮肤3～4个月,平均注水（80．51±3．87）ml,达预定量后稳定养护1个月。Ⅱ期：取自体肋软骨,雕刻成由4层软骨构成的耳支架,整体为倒立的海螺样外观,将扩张皮瓣覆盖于整个自体肋软骨支架表面,再造耳廓。Ⅲ期：Ⅱ期术后3个月对成形耳进行细节性修整。结果21例患者手术均获成功,成形耳廓大小、外形均与健侧相似,医患双方满意。结论耳后乳突区皮肤扩张法所扩张的皮肤,可覆盖于整个自体肋软骨支架表面,术后耳廓外形逼真,立体感强。     

A comprehensive review of the great auricular nerve graft

Neurosurgical Review - The great auricular nerve (GAN) is a superficial branch of the cervical plexus that innervates parts of the mandible, auricle, and earlobe. Over the past 30 years,...