显微镜下功能性腮腺切除术治疗腮腺良性肿瘤42例

目的 评价显微镜下功能性腮腺切除术治疗腮腺良性肿瘤的临床疗效。方法 采用显微镜下功能性腮腺切除术,治疗腮腺浅叶良性肿瘤患者42例。该术式较传统术式改良之处主要有：全程显微镜下手术直观准确;切口改良、美容;腮腺嚼肌筋膜下翻瓣;解剖保留耳大神经后支和腮腺导管;只解剖暴露面神经的部分分支;包括肿瘤在内的腮腺浅叶部分切除;胸锁乳突肌肌瓣填塞术腔等。结果 42例术后出现面神经损伤3例(7.1%),损伤均为暂时性;出现Frey综合征者1例(2.4%);发生涎瘘者0例;5例(11.9%)患者术后出现不同程度的耳垂和耳郭背部皮肤感觉减弱;术后局部凹陷不明显,患者对颜面部外观满意。术后随访1～5年,未见肿瘤复发。结论 显微镜下功能性腮腺切除术治疗腮腺良性肿瘤,既降低手术并发症发生率,又可取得良好美容效果。     

腮腺良性肿瘤手术改良的临床研究

目的 评价改良腮腺部分切除术治疗腮腺良性肿瘤的临床效果.方法 采用腮腺部分切除术治疗腮腺良性肿瘤118例,术式改良包括切口改良,腮腺嚼肌筋膜深面翻瓣,保留腮腺导管,解剖并保护耳大神经,术区负压引流等.结果 本组患者术后出现面神经损伤11例(9.2%),损伤均为暂时性,在术后3个月内全部恢复正常;涎瘘及积液5例(4.2%),经加压包扎后消失.术后采用微量碘淀粉试验(Minor试验)检查了14例患者的面部腮腺区出汗情况(Frey综合征),仅1例(7.1%)患者手术区域皮肤颜色与对照侧有轻微的改变.37例(31.4%)患者术后出现不同程度的耳垂麻木,除5例术中切断耳大神经外,其余病例术后3个月内均恢复.对118例患者术后随访2～5年(其中83例行超声检查),未见肿瘤复发,均可见导管口有不同程度清亮液体溢出.术后局部凹陷不明显,患者满意.结论 腮腺良性肿瘤手术改良不仅降低了术后并发症的发生率,同时还保留了残余腺体的分泌功能,临床效果满意.     

腮腺浅叶良性肿瘤功能性手术的初步探讨

目的:探讨功能性手术在腮腺浅叶良性肿瘤治疗中的应用.方法:从手术切口、耳大神经保留、区域性面神经解剖、腮腺浅叶部分切除术和凹陷性畸形整复等多个方面对腮腺浅叶良性肿瘤的手术方法进行改良和综合应用.回顾分析21例患者术后复发率及术后功能、并发症的情况.结果:随访未见肿瘤复发,无明显凹陷畸形,保留耳大神经者耳周感觉异常区域较...     

改良的腮腺良性肿瘤切除术

解剖面神经的腮腺浅叶切除术或全切术已成为腮腺良性肿瘤手术的标准术式.术后遗留面部凹陷畸形及常见的局部味觉性出汗情况,对患者的心理、工作生活和社交带来负面的影响.作者对2004～2005年采取了保留腮腺咬肌筋膜的腮腺切除术和胸锁乳突肌瓣转移修复治疗的13例腮腺良性肿瘤患者进行回顾性分析,报道如下.     

功能性手术在治疗腮腺尾叶良性肿瘤中的临床应用

目的通过与传统术式比较,探讨功能性手术在腮腺尾叶良性肿瘤治疗中的临床应用。方法 72例腮腺尾叶良性肿瘤患者随机分为两组,传统术式组（38例）保留面神经,行肿瘤及腮腺浅叶切除术;功能性术式组（34例）行C形切口,保留面神经及耳大神经,行肿瘤及腮腺浅叶部分切除术,酌情行胸锁乳突肌瓣整复。所有患者术后随访0.5-5年,观察两组术后并发症发生率及肿瘤复发情况。结果两组患者肿瘤复发、涎漏、口干差异无统计学意义（P均〉0.05）,但两组术后暂时性面瘫、Frey综合征、耳廓区麻木感、面部凹陷畸形发生率差异具有统计学意义（P均〈0.05）。结论功能性腮腺切除术治疗腮腺尾叶良性肿瘤,术后并发症少,优于传统术式。     

保留腮腺导管的腮腺浅叶部分切除术

目的总结腮腺良性肿瘤保留导管的浅叶部分切除术的效果.方法对27例腮腺良性肿瘤保留导管的浅叶部分切除术患者进行回顾分析,评价面外形改变,腮腺的分泌功能,面神经损伤情况,唾液积潴,术后复发.结果经过1年～5年的门诊复诊及随访发现,面外形无凹陷畸形,面神经无损伤,无涎瘘形成.保留的残余腺体有涎液分泌,肿瘤无复发.结论认为保留腮腺导管的良性肿瘤浅叶部分切除术是一种可行性术式并具有很好的临床价值.     

保留腮腺咬肌筋膜在预防Frey综合征中的应用

腮腺良性肿瘤目前仍以手术治疗为主,经典手术方法是保留面神经的腮腺浅叶或全叶加肿瘤切除术,但术后Frey综合征发生率较高,会造成严重后果,常给患者造成较大的精神痛苦,影响患者的生活质量。为探讨如何预防、减少腮腺肿瘤术后Frey综合征的发生,本研究采用保留腮腺咬肌筋膜关闭腺体创面,预防Frey综合征,效果满意。     

保留腮腺浅叶手术治疗腮腺深叶良性肿瘤21例分析

目的探讨保留腮腺浅叶手术治疗腮腺深叶良性肿瘤的可行性。方法对1998～2012年收治的21例腮腺深叶良性肿瘤行保留腮腺浅叶手术切除肿瘤,并对手术疗效进行总结分析。结果采用保留腮腺浅叶手术治疗腮腺深叶良性肿瘤的21例患者术后无明显面部畸形、腮腺分泌功能良好,无Frey综合征;1例面神经损伤1个月后恢复;1例术后出现积液,加压包扎后痊愈。结论对于腮腺深叶良性肿瘤行保留浅叶腮腺深叶肿瘤切除术,术后面部畸形不明显,满足患者的美容要求,其他并发症少,值得临床推广应用。     

腮腺多形性腺瘤28例术后分析

我院自 1 986～ 1 997年共收治腮腺多形性腺瘤2 8例 ,均手术治疗 ,现报告如下。1 　 资料与方法2 8例中 ,男 1 0例 ,女 1 8例 ;年龄 2 2 65岁 ,平均3 9岁。左侧 1 6例 ,右侧 1 2例。腺瘤位于腮腺浅叶者 2 7例 ,位于腮腺深叶者 1例 ,术前均无面神经功能障碍。1 986～ 1 992年 ,采用单纯多形性腺瘤摘除术 6例 ;1 993 1 997年采用经典的保留面神经的腮腺切除术 2 2例 ,其中多形性腺瘤加腮腺浅叶切除术 2 1例 ,多形性腺瘤加腮腺全切除术 1例 ,术中均转移胸锁乳突肌肌瓣覆盖面神经和耳颞神经 ,术中保留腮腺主导管者 1 2例。2 　 结果采用单纯多形…     

耳后沟切口在腮腺肿瘤手术中的应用北大核心CSCD

目的探讨耳后沟切口在腮腺浅叶良性肿瘤手术中的应用。方法回顾性分析2015年5月至2017年3月就诊于临沂市人民医院耳鼻咽喉科,采用耳后沟切口行腮腺浅叶良性肿瘤切除术的患者20例,男性12例,女性8例,年龄12~66岁,其中混合瘤15例,腺淋巴瘤5例。术中总干法寻找面神经,向远心方向解剖面神经颈面干、颞面干及周围支,切除腮腺浅叶及肿瘤,并转移胸锁乳突肌瓣充填腮腺缺损区。分析总结患者术中及术后随访情况。结果20例患者手术均顺利完成。所有患者术后随访2年,无复发,没有出现涎瘘及Frey综合征,无影响容貌的瘢痕,术区无凹陷畸形。结论耳后沟切口行腮腺浅叶切除及面神经解剖切口隐蔽、面神经解剖简单,可同时行胸锁乳突肌瓣修复术区组织缺损,具有美容及并发症少的优点。     

Mucoepidermoid carcinoma arising in the accessory parotid gland.

A rare case of a 9-year-old female with mucoepidermoid carcinoma arising in the accessory parotid gland is reported. She had complained of a painless and round mass of the left cheek for a duration of 14 months. Sialography, ultrasonography, CT scan and MRI were performed preoperatively. Sialography revealed a small duct separating from the Stensen's duct. CT and MRI showed that the tumor with smooth outline was lying on the masseter muscle and detached from the main parotid gland. The preoperative diagnosis was an accessory parotid gland tumor. The tumor was removed without facial nerve injury via standard parotidectomy incision. The tumor was composed of mucous and epidermoid cells. The pathological diagnosis was low-grade mucoepidermoid carcinoma.     

Minimally invasive surgery for parotid pleomorphic adenoma

Compared with total parotidectomy and complete superficial parotidectomy for the removal of a parotid pleomorphic adenoma, partial superficial parotidectomy with dissection and preservation of the facial nerve--defined as the excision of a tumor with a 2-cm margin of normal parotid parenchyma except at the point where the tumor abuts the facial nerve--is associated with a lower incidence of transient facial nerve dysfunction, facial contour disfigurement, and subsequent Frey's syndrome. The partial procedure is not associated with any increase in recurrence, and it requires less operating time. The author hypothesized that the use of this procedure to remove a benign pleomorphic adenoma might result in even less morbidity (transient or permanent facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and hypoesthesia) without increasing the risk of recurrence if only a 1-cm margin of normal parotid parenchyma was removed and if the posterior branches of the great auricular nerve were preserved To test this hypothesis, the author conducted a retrospective study of 30 patients--15 who had undergone the standard partial procedure (2-cm margin with great auricular nerve sacrifice) and 15 who had undergone the modified version (1-cm margin with great auricular nerve preservation). After a mean follow-up of 10 years, there were no significant differences between the two groups in terms of facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and recurrence. Moreover, preservation of the posterior branches of the great auricular nerve did not prevent alterations in sensitivity (i.e., hypoesthesia) in 7 of the 15 patients (46.7%). Although a 1-cm area of normal parotid parenchyma around a benign pleomorphic adenoma was a safe margin, it was no better than a 2-cm margin in terms ofmorbidity and recurrence. Preservation of the posterior branches of the great auricular nerve will result in an objective reduction in hypoesthesia in approximately half of patients, but because it does not ensure freedom from sensitivity alterations in all cases, patients should be advised of the risk of postoperative numbness in the earlobe and the infraauricular area.     

A case of buccal abscess; originating from an ectopic accessory parotid gland?

We report a case of an abscess from an 'ectopic' accessory parotid gland in the cheek demonstrated by sialography and computed tomography (CT). The accessory parotid gland was ectopically located anterolateral to the masseter muscle and isolated from the main parotid gland. The orifice and ductal system of the ectopic accessory parotid gland were separated from those of Stensen's duct. The abscess developed from this ectopic accessory gland, and the main parotid gland was free of inflammation. Using sialography and CT, we confirmed the presence of this ectopic accessory gland.     

Randomized prospective study of the validity of the great auricular nerve preservation in parotidectomy

OBJECTIVE: To evaluate the feasibility and validity of great auricular nerve preservation during parotidectomy. METHODS: Thirty patients with parotid tumors were randomized to 2 groups. Sixteen patients (group A) underwent classic parotidectomy with sacrifice of the great auricular nerve. The surgeon tried to spare the nerve in the 14 patients (group B). Tactile sensitivity, pain sensitivity, and tactile discrimination were evaluated preoperatively and at 7 days, 30 days, 6 months, and 12 months after surgery. The regions examined were the superior helix, lobule, and infra-auricular and posterior auricular regions. RESULTS: After surgery, both groups showed lower levels of sensitivity, mainly in the lobule and in the infra-auricular region. These alterations were less pronounced in group B. Both groups showed improvement over time. In group B the tactile sensitivity reached preoperative levels by 6 months after surgery. The recuperation in group A was partial and stabilized at 6 months after surgery. CONCLUSION: Great auricular nerve preservation is technically feasible during parotidectomy, with a decrease of the sensitivity alterations in the early postoperative period and avoidance of the permanent sequelae that occur when the nerve is sacrificed.     

Stenon's or Stensen's duct carcinoma

Carcinomas arising from the Stensen's duct are extremely rare, and only 28 cases have been reported since 1927. Only two cases of the whole were adenoid cystic carcinoma like our case. A 83-year-old man with painless tumour of the left cheek is reported. The tumour was removed without facial nerve injury via extended parotidectomy incision and after superficial lobectomy.     

改良面部除皱切口在腮腺浅叶肿瘤切除术中的应用

目的：评价改良面部除皱切口在腮腺浅叶肿瘤切除术中的应用价值。方法：采用改良面部除皱切口,实施面神经解剖加腮腺浅叶部分（或腮腺浅叶）切除术35例,观察该入路的术野暴露、美观程度及并发症发生率。结果：所有病例术野暴露良好,均完整切除肿瘤。术后面神经下颌缘支暂时性麻痹5例（14．3％）,暂时性耳垂麻木6例（17．1％）,均在1～3个月后缓解;无涎瘘;术后3个月患者平均客观美容满意度评分8．5分,所有患者对术后美容效果满意。随访24～60个月（中位随访期：48个月）,未见肿瘤复发。结论：改良面部除皱切口应用于腮腺浅叶肿瘤切除,术野暴露良好、切口相对隐蔽、术后美容效果良好、无明显并发症,值得临床推广应用。     

Diagnosis and management of pain syndromes following parotidectomy

The preservation of the great auricular nerve in parotid gland surgery for benign disease is discussed controversially. The negative impact on quality of life due to lack of sensation in the auricle was underestimated in former times. Thus, more and more surgeons try to preserve the nerve with rising incidence of possible complications like neuralgia. We report on three patients with postoperative neuralgia of the great auricular nerve. Two patients experienced a long lasting remission of their neuralgia after an infiltration of the punctum nervosum with a local anesthetic. In a third patient the great auricular nerve had to be resected 6?months after parotidectomy. Other options of therapy are described.     

Diagnostik und Management von Schmerzsyndromen nach Parotidektomie

The preservation of the great auricular nerve in parotid gland surgery for benign disease is discussed controversially. The negative impact on quality of life due to lack of sensation in the auricle was underestimated in former times. Thus, more and more surgeons try to preserve the nerve with rising incidence of possible complications like neuralgia. We report on three patients with postoperative neuralgia of the great auricular nerve. Two patients experienced a long lasting remission of their neuralgia after an infiltration of the punctum nervosum with a local anesthetic. In a third patient the great auricular nerve had to be resected 6?months after parotidectomy. Other options of therapy are described.