鼻咽部血管纤维瘤翼腭窝入路摘除术

报道鼻咽部血管纤维瘤经翼腭窝入路的手术方法，可满意显露鼻咽、翼腭窝和颞下窝三个区域，将侵入上述三区的瘤体整体取出。这一入路无损伤颞颌关节、面神经、中耳和咽鼓管的缺点，手术时可窥及肿瘤与窝周诸壁的关系，可避免损及中颅底、鞍旁、海绵窦和破裂孔、颈动脉等重要构造。手术共４例，随访３～５年无复发。     

面中掀翻上颌骨拆装进路切除鼻咽血管纤维瘤

目的:探讨应用面中掀翻上颌骨拆装进路治疗Ⅲ、Ⅳ期鼻咽血管纤维瘤患者的可行性。方法:回顾性分析2001年2月~2004年8月应用面中掀翻上颌骨拆装进路治疗7例Ⅲ、Ⅳ期鼻咽血管纤维瘤的临床资料。采用Fisch分期,Ⅲ期患者5例,Ⅳ期患者2例;2例Ⅲ期患者接受面中掀翻联合同侧上颌骨拆装进路,接受面中掀翻联合LefortⅠ患者5例(Ⅲ期3例、Ⅳ期2例),其中1例Ⅳ期患者因颅内肿瘤侵犯范围较广采用颅面联合进路。6例术前行超选择性瘤体供血动脉栓塞(Ⅲ期患者4例、Ⅳ期患者2例)。结果:术中出血量为(600±324)ml。6例动脉栓塞患者术中出血量为(483±165)ml。1例未栓塞患者出血量1 300 ml。手术时间为(129±22)min。7例患者术后病理为鼻咽血管纤维瘤。6例患者术后随访2.5~6.0年未见肿瘤复发。1例接受术前行超选择性瘤体供血动脉栓塞Ⅲ期患者术后1年肿瘤复发,再手术后随访至今未见复发。结论:对于Ⅲ、Ⅳ期患者,面中掀翻上颌骨拆装不仅利于术中显露肿物达到根治性切除,缩短手术时间、减少术中出血量而且术后美容佳、功能恢复好。术前行血管造影及血管栓塞对减少术中出血量、降低肿瘤复发率具有重要临床意义。     

侵及颞下窝和翼腭窝肿瘤的手术治疗

对3例由邻近组织的肿瘤侵犯颞下窝和翼腭窝的患者行手术治疗。2例为腮腺粘液表皮样癌侵及者，其中1例采用颈颌入路切除腮腺和颞下窝与翼腭窝肿瘤；1例是因术后复发，术中对复发灶切除后，直接暴露颅底，手术缺损用胸大肌肌皮瓣和背阔肌肌皮瓣修复。另1例是由鼻咽和腭部肿瘤侵及者，采用上颌骨掀开入路切除原发病灶，同时切除颅底肿瘤。表明，对由邻近组织肿瘤侵犯颞下窝和翼腭窝者，手术治疗时，采用上颌骨掀开入路，只要将颅底手术野予以充分暴露，就可以获得较好的治疗效果。     

鼻咽血管纤维瘤手术治疗51例分析

目的比较鼻咽血管纤维瘤的治疗方法。分析各手术方式及术前超选择性动脉栓塞对不同分期患者治疗的优缺点。方法回顾性分析1989年2月—2004年10月51例鼻咽血管纤维瘤手术方式,采用Fisch分期,Ⅰ、Ⅱ期患者33例,经腭进路22例,鼻内镜手术11例;Ⅲ、Ⅳ期患者18例,经鼻侧切开9例,面中掀翻+LefortⅠ或同侧上颌骨拆装4例,颅面联合进路5例。51例患者中23例术前行超选择性瘤体供血动脉栓塞,其中Ⅳ期7例,Ⅲ期8例,Ⅱ期5例,Ⅰ期3例。结果术中平均出血量为1010ml,23例选择性瘤体供血血管栓塞患者,术中出血量200~870ml,平均485ml(x-±s,485ml±202ml);未栓塞组出血量500~3500ml平均1600ml(1600±757)ml,栓塞组平均出血量低于未栓塞组平均出血量(t=7·48,P<0·05)。术后1次复发8例,2次复发2例。术后复发时间平均为26·4个月(9~48个月)。结论术前行血管造影及血管栓塞对减少术中出血量具有临床意义。对于Ⅰ、Ⅱ期的患者,选择鼻内镜手术,可以避免传统手术创伤对患者术后颅面部生长发育的影响。对于Ⅲ、Ⅳ期患者,采用面中掀翻、LefortⅠ或同侧上颌骨拆装不仅有利于肿物的根治性切除,而且能够达到术后咬合关系影响小和美容佳的目的。     

累及翼突鼻咽纤维血管瘤的手术方法—附5例报告

目的：探讨源于翼突鼻咽纤维血管瘤的手术治疗方法和意义。方法：采用硬腭－唇龈联合进路，切除上颌结节部和部分上颌窦后外侧壁，暴露翼突内外板，将翼突与肿瘤整块切除。结果；5例随访，5年1例，3年，2年各2例，均无复发。结论：切除肿瘤附着的翼突，防止肿瘤术后复发和术中出血是有效的。     

鼻咽血管纤维瘤临床分析

鼻咽血管纤维瘤为鼻咽部常见的良性肿瘤,常发生于10～25岁的男性青年,因肿瘤血管丰富,并可向颅底、颅内、眼眶、颞部和鼻窦等处侵犯扩展,手术切除困难。我科自1998～2002年共诊治45例,报告如下。     

复发性鼻咽血管纤维瘤

目的探讨复发性鼻咽血管纤维瘤的临床特征,减少复发率,进一步提高诊治水平。方法回顾分析了16例复发性鼻咽血管纤维瘤的症状、体征、CT及MRI表现、手术方法和径路,手术效果及复发因素。结果手术后平均复发时间为8个月,其中1次复发9例,2次复发5例,3次复发2例,肿瘤的复发与肿瘤的分期有关;术中出血量与患者的年龄、病程、肿瘤的分期及手术径路的选择有关。结论术前充分了解肿瘤的范围是降低复发率的关键,选择合适的手术径路是降低复发率的必要措施,完全彻底的切除肿瘤是降低复发率的根本保证。     

改良面中部掀翻术切除鼻腔鼻窦肿瘤

资料与方法:鼻腔鼻窦肿瘤病人16例中,男12例,女4例.年龄28～78岁,平均46岁.鼻腔鼻窦内翻性乳头状瘤10例,上颌窦血管瘤4例,上颌窦浆细胞肉芽肿1例,双鼻腔、筛、蝶窦软骨瘤1例.病程6个月～10年.全部病例术前均作鼻窦CT扫描.16例中仅1例因软骨瘤侵犯双鼻腔、筛窦、蝶窦达前颅窝底而行双侧改良面中部掀翻术切除肿瘤;另15例病变仅位于一侧鼻腔及鼻窦,均以单侧改良面中部掀翻术完成手术.病人仰卧,肩下垫枕,气管插管全麻,切口局部注射适量0.9%氯化钠加1‰肾上腺素,以减少出血.切口:①双侧唇龈沟上0.5cm切开粘骨膜,若病变仅限于一侧,则该切口达对侧尖牙或第1磨牙上方即可.沿骨膜下分离软组织,术侧达眶下孔,对侧达梨状孔,暴露上颌骨前鼻棘;②鼻小柱与鼻中隔间贯通切口,在相当于大翼软骨内侧脚和鼻中隔软骨前缘之间作贯通切口达鼻前庭底;③鼻前庭底部切口,从切口②末端继续向外下沿前庭底部相当于梨状孔下缘作皮肤切口,达鼻翼软骨内侧,至此②③切口互相连接成"C"形切口.与经典面中部掀翻术切口圈状省略了鼻侧软骨与鼻翼软骨切口.同时,沿梨状孔缘外切开鼻腔外壁粘膜.用2根纱条由双侧鼻前孔穿入,将上唇、鼻锥前部、面中部软组织牵拉向上翻起,可暴露面中部骨性结构,根据肿瘤部位及手术需要,切除上颌窦前壁、内壁及上颌骨额突后切除肿瘤.本组1例双侧鼻腔、筛窦、蝶窦软骨瘤,达前中颅底,经此法切除全部肿瘤.术腔均以明胶海绵及碘仿纱条填塞.     

累及翼腭窝肿瘤的鼻内镜下治疗

翼腭窝毗邻结构复杂,累及此处肿瘤的治疗方式包括传统入路和鼻内镜入路。就翼腭窝的解剖、翼腭窝肿瘤的种类以及鼻内镜手术治疗方式进行阐述。     

Aural cholesteatoma extending into the posterior fossa

The case of a residual aural cholesteatoma extending into the posterior cranial fossa after radical mastoidectomy is presented. The importance of distinguishing this lesion from primary cholesteatoma of the cerebellopontine angle is discussed. The safety of canal-wall-down procedures is also discussed.     

Middle turbinate osteoma extending into anterior cranial fossa

Middle turbinate osteoma is very rare and only two times have been reported before. We reported a 31-year old male presenting middle turbinate osteoma that extending into the anterior cranial fossa, causing pneumocephalus. The osteoma was resected by combining endoscopic sinus surgery with bifrontal craniotomy and the patient was relieved of headaches.     

A case of recurrent aural cholesteatoma extending into the middle cranial fossa

A case of aural cholesteatoma extending into the middle cranial fossa is presented. The cholesteatoma appears to have recurred in an ear in which a radical mastoidectomy had been performed more than 40 years earlier. The patient complained only of a vague sensation of heat in the head and did not manifest distinct neurologic signs or symptoms. The cholesteatoma was removed through an extended endaural approach. Extension of aural cholesteatoma beyond the confines of the temporal bone appears to be quite unusual.     

手术治疗侵犯翼腭窝的鼻咽纤维血管瘤的方法(附5例报告)

目的：探讨手术治疗侵犯翼腭窝的鼻咽纤维血管瘤的方法。方法：采用硬腭－唇龈联合路径,切除上颌结节部和部分上颌窦后外侧壁,暴露翼突内外板,整块切除翼突与肿瘤。结果：随访2～5年均无复发。结论：经硬腭－唇龈联合路径切除上颌结节部和部分上颌窦后外侧壁及翼突内外板是治疗突入翼腭窝鼻咽纤维血管瘤的有效方法。     

Endoscopic management of benign tumors extending into the infratemporal fossa: a two-surgeon transnasal approach

OBJECTIVES/HYPOTHESIS: Preliminary results of the endoscopic two-surgeon technique for the management of benign infratemporal fossa tumors are presented. METHODS: Four patients with juvenile nasopharyngeal angiofibroma, a patient with an inverting papilloma, and a patient with a maxillary nerve schwannoma were reviewed. The average age was 22.7 years; the male-to-female ratio was 5:1. The endoscopic anatomy and surgical technique are presented. RESULTS: The two-surgeon technique allowed complete resection of all six tumors extending into the infratemporal fossa. There has been no recurrence of tumor within the infratemporal fossa, after a mean follow-up of 31.3 months (SD = 11.2 mo). CONCLUSION: The two-surgeon transnasal technique allows benign infratemporal fossa tumors to be resected endoscopically.     

Maxillary sinus nonodontogenic myxoma extending into the sphenoid sinus and pterygopalatine fossa: case report

Myxomas are benign mesenchymal tumors of uncertain etiology. They can arise from odontogenic tissue, as well as from the sinonasal tract and from the facial and temporal bones, apparently from nonodontogenic mesenchyme. Although histologically benign, myxomas are locally invasive. Histopathology demonstrates a characteristically hypocellular lesion with loose stellate cells. We describe the case of a 48-year-old woman with a nonodontogenic maxillary sinus myxoma that invaded the sphenoid sinus and pterygopalatine fossa. We removed the mass via a combined endoscopic and gingivobuccal approach. The rarity of a nonodontogenic sinonasal myxoma extending into the sphenoid sinus and pterygopalatine fossa is the basis for our presentation of this case.     

Fibromatosis of the infratemporal fossa extending to the parapharyngeal space accompanied by trismus

Fibromatosis is a tumor of fibroblastic origin that may arise in any musculoaponeurotic structure. Although fibromatosis is histologically benign, it has a tendency to invade surrounding tissues and often recur locally after treatment. A 34-year-old female patient was presented with pain in the left buccal region, left loss of visual acuity, and trismus. Computed tomographic scans revealed a large mass in the infratemporal fossa and parapharyngeal space. An open biopsy was performed and the pathological diagnosis was a fibromatosis. Surgical treatment for her trismus was performed simultaneously.     

Cholesteatoma extending into the internal auditory meatus

We report our experiences in managing a patient with cholesteatoma complicated by meningitis, labyrinthitis and facial nerve palsy. The antero-inferior half of the tympanum was aerated but the postero-superior portion of the tympanic membrane was tightly adherent to the promontry mucosa. An attic perforation was present at the back of the malleolar head. High-resolution computed tomography also uncovered a fistula in the lateral semicircular canal. Surgical exploration of the middle ear cavity demonstrated that both the vestibule and cochlea were filled with cholesteatoma, and the cholesteatoma extended into the internal auditory meatus through the lateral semicircular canal fistula. The cholesteatoma was removed by opening the vestibule and cochlea with a preservation of the facial nerve. Post-operatively, an incomplete facial palsy remained, but has improved slowly. There is no sign of recurrence to date after a 3-year period of observation.