经口内入路副腮腺良性肿瘤切除术5例报告

目的：探讨经口内入路手术治疗副腮腺来源良性肿瘤的适应证、手术方法及疗效以提高诊疗水平。方法：回顾性分析上海交通大学医学院附属第九人民医院口腔颌面头颈-肿瘤科5例经口内入路切除副腮腺肿瘤病例的临床表现、影像学表现及治疗经过。结果：5例病例均经口内入路完整切除副腮腺区肿物。术后2周、3个月、6个月随访，患者口内创口内愈合良好，未出现腮腺导管损伤、面神经损伤症状。结论：经口内入路的副腮腺肿物切除术更适用于活动度大、边界清晰、与周围组织无粘连的良性肿瘤，其临床治疗效果良好，避免了面部切口瘢痕，美容效果好，患者满意度高。     

美容切口在腮腺肿瘤外科中的应用

目的 评价腮腺美容切口在腮腺肿瘤切除术中应用的临床价值.方法 收集28例腮腺肿瘤患者,采用由面部除皱切口改良而来的腮腺美容切口入路,进行保留面神经和耳大神经的腮腺切除术,并联合颈清拐杖式切口手术入路,治疗腮腺恶性肿瘤.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Ⅰ期愈合,无涎瘘发生.1例患者术后出现暂时面瘫,2个月后恢复.所有患者术后均出现不同程度的耳垂麻木,除3例患者耳大神经损伤外,其余患者耳垂麻木于术后2个月恢复.患者对该切口的美观程度十分满意.结论 腮腺美容切口入路隐蔽,美容效果好,腮腺任何部位的肿瘤都可以采用此术式.     

咽旁间隙肿瘤手术入路10例分析

目的 :探讨咽旁间隙肿瘤的手术入路。方法 :对2013-01—2013-07经手术的10例咽旁间隙肿瘤患者的手术入路进行分析。结果:经口内入路、经颈侧入路、颈-腮腺联合入路、经颈-下颌骨裂开入路被用于切除肿物,全部获得成功;经口内入路术中和术后并发症少,术后无面颈部皮肤切口瘢痕形成。选择入路时主要考虑肿瘤的位置、大小以及组织病理分型。结论:咽旁间隙肿瘤切除,术前借助CT和MRI成像技术对肿瘤进行分析,多种入路均可有效切除肿瘤,经口内入路无皮肤切口瘢痕,美容效果较好。     

美容切口显微镜辅助下行腮腺良性肿瘤切除术38例报告

目的：观察借助显微镜经耳周美容切口行腮腺良性肿瘤切除术的临床效果。方法：38例腮腺区肿瘤患者,经耳周美容切口入路,显微镜下行面神经解剖、腮腺良性肿瘤切除术,观察患者的术后情况。结果：38例患者腮腺区肿瘤均被完整切除,除1例出现暂时性口角歪斜外,其余患者无面瘫。结论：借助显微镜,采用美容切口行腮腺良性肿瘤切除术,术后创伤少,创区及切口外形美观,随访无复发,患者满意。     

耳周定点法设计腮腺除皱美容切口的临床研究

目的:探讨一种简便易行的腮腺除皱美容切口耳周定点方法。方法:收集2011年4月~2013年5月腮腺良性肿瘤患者11例,采用耳周定点法指导腮腺除皱美容切口设计,进行腮腺区肿瘤及腺体切除。结果:11例患者均顺利完成手术,其中行腮腺浅叶及肿瘤切除术9例,腮腺全叶及肿瘤切除术2例,术后1年随访,患者均对瘢痕隐蔽情况和手术预后表示满意。结论:耳周定点法设计腮腺除皱美容切口,解剖标志明确,简便易行,可操作性强,值得临床推广应用。     

副腮腺肿瘤14例临床分析及治疗体会

目的 初步评估分析副腮腺肿瘤的诊断、治疗与预后情况。方法 回顾性分析14例副腮腺肿瘤患者的诊断与治疗,考虑到副腮腺肿瘤的特殊解剖部位,14例患者均采取常规的腮腺肿瘤手术切口,并进行细致的面神经解剖。对于恶性副腮腺肿瘤给予术后辅助放射治疗。结果 14例副腮腺肿瘤中多形性腺瘤6例,肌上皮瘤2例,腺泡细胞癌2例,基底细胞腺瘤1例,中分化黏液表皮样癌1例,肌上皮癌1例,侵袭性纤维瘤1例。所有患者术后的面型满意,肿瘤无复发。结论 常规的腮腺手术切口进路治疗副腮腺肿瘤是一种安全、有效、美观的方法。     

内镜入路下腮腺肿瘤手术研究进展

腮腺肿瘤是口腔科门诊中最常见的唾液腺肿瘤。现行标准的治疗方法是面神经解剖+腮腺肿瘤的扩大切除术。然而此手术方式会在患者面颈部遗留明显瘢痕。随着患者对颜面部美观程度的重视,减少瘢痕成为临床医师亟待解决的一个问题。解决这一问题的主要思路有两个,一是通过不断改良手术的切口即使用美容切口,力争使用更小更隐蔽的切口来完成手术所需的暴露;二是借助内镜系统,使用相对较小的手术切口作为内镜入路,人为制造腔隙,使用内镜切除肿物。随着影像学技术和微创手术器械的发展,内镜技术越来越多地应用在临床手术中。在口腔颌面外科领域,自2000年第1例腮腺内镜手术成功后,内镜因其具有良好美学效果而成为越来越多临床医师和患者的选择。本文就目前内镜方法切除腮腺肿瘤的手术切口及优缺点展开综述。     

隐蔽切口入路内镜辅助颈部肿物切除效果初探

目的探索评价颌面部隐蔽切口入路内镜辅助下颈部良性肿瘤切除的新术式。方法选取2018年1月至2019年8月于山东大学齐鲁医院口腔颌面外科就诊的颈部良性肿瘤患者17例(颏下区3例,下颌下区2例,腮腺后下极9例,胸锁乳突肌上区1例,胸锁乳突肌中区1例,胸锁乳突肌下区1例)。术前行CT检查,评价肿瘤大小、边界、形态、性质,根据肿瘤所在区域设计不同部位隐蔽切口,颏下区及下颌下区肿物选用口内前庭沟入路,腮腺后下极及胸锁乳突肌区肿物选用耳后隐蔽小切口入路。术中采用自制的"口腔手术用造腔装置"辅助牵拉完成颈部"造腔",内镜辅助下将肿物完整摘除,术后每3个月定期随访。结果所有手术均按预期完成,术后3个月复查时,视觉模拟量表平均为9.3分,患者对切口设计及手术整体效果均表示满意,术后1~15个月随访均未见复发。结论采用隐蔽切口入路内镜辅助颈部良性肿物切除是一种切口不明显、具有良好美容效果的手术方法。     

耳前、下颌下切口治疗咽旁颞下窝肿瘤

目的：探讨咽旁颞下窝肿瘤合适的手术入路及手术方法,减少并发症发生。方法：对本院2007年9月至2009年4月7例咽旁颞下窝肿瘤患者进行临床回顾性分析,结合术前影像学检查,行耳前、下颌下切口手术切除肿瘤。结果：所有患者手术顺利,未出现术后并发症。随访2个月至3年,无1例复发。结论：对于边界相对较清楚的咽旁颞下窝肿瘤,单纯耳前、下颌下切口可顺利切除肿瘤,该手术人路创伤小,术后并发症少。     

下颌骨旁正中劈开入路在治疗腮腺深叶巨大肿瘤中的应用

采用下颌骨旁正中劈开入路切除腮腺深叶巨大肿瘤在临床上应用不多。本文报告采用下颌骨旁正中劈开入路切除腮腺深叶巨大肿瘤1例,并对腮腺深叶巨大肿物切除的手术入路进行文献复习及讨论。患者术后随访,无复发,效果满意。     

Minimally invasive endoscopic resection of benign tumours of the accessory parotid gland: an updated approach

The most common conventional approaches for the resection of benign tumours in the accessory parotid gland are a standard parotidectomy incision, a modified standard parotidectomy incision, or a face-lift incision. The resulting scars may severely affect the patient's postoperative appearance. The previously reported endoscopically assisted approach offers a less aesthetically invasive technique, but it may still leave a visible preauricular scar 4–5 cm long. We have used a modified endoscopic approach with minimal, and concealed, incisions for the resection of benign tumours in the accessory parotid gland. Five patients were diagnosed by physical examination, imaging, and preoperative fine-needle aspiration biopsy. They had endoscopically assisted resections using our modified approach, and we evaluated its feasibility. All the resections were successful. The mean operating time was 108 min (range 90–130). The postoperative scars were concealed and aesthetically satisfactory. There were no facial paralyses, salivary fistulas, or recurrences in the short term. Using endoscopically assisted resection we completely removed benign tumours from the accessory parotid gland and obtained good aesthetic results. Our updated endoscopic approach for these resections is successful with shorter, concealed incisions. It is a viable alternative to conventional approaches.     

改良耳后发际切口联合蒂在下胸锁乳突肌瓣在腮腺良性肿瘤切除术中的应用研究

目的 评价改良耳后发际切口联合蒂在下胸锁乳突肌瓣修复腮腺良性肿瘤中的应用价值.方法 回顾性分析48例接受腮腺良性肿瘤切除术的患者,其中试验组采用改良耳后发际切口联合蒂在下胸锁乳突肌瓣修复19例,对照组采用改良美容切口29例,比较两组的手术时间、术后引流量、术后美观程度及术后面神经麻痹、涎瘘、Frey综合征的发生率.结果...     

Preauricular transcondylar approach for basal cell adenoma of parotid coexist with ganglion cyst of the ipsilateral temporomandibular joint

The concurrence of 2 independent neoplasias in the ipsilateral parotid and the temporomandibular joint (TMJ) region was infrequently reported. In this article, we present a unique case characterized by the coexistence of a rare salivary gland tumor, basal cell adenoma, of the parotid gland with a ganglion cyst in the ipsilateral TMJ region. A special surgical procedure was also presented here using a modified preauricular incision and transcondylar approach for extracapsular dissection of both lesions. Previously published literature are about the traditional treatment of benign parotid tumors using partial or total parotidectomy with the preservation of facial nerve mainly via an S-shaped submandibular incision and approach. Here, for the first time, a special surgical method using preauricular transcondylar approach for this unique case of synchronous occurrence of parotid tumor and TMJ cyst is reported.     

耳后发际联合耳屏缘切口在腮腺上极良性肿瘤切除术的应用

目的 探讨耳后发际联合耳屏缘切口在腮腺上极良性肿瘤切除术的临床效果.方法 采用耳后发际联合耳屏缘切口对20例腮腺上极良性肿瘤行手术治疗并分析其疗效与美容效果.结果 20例患者腮腺上极良性肿瘤均被顺利完整切除,术中冰冻及术后常规病理报告均为良性.术后2例出现暂时性耳垂麻木,1例出现暂时性面神经颧支麻痹,1例发生术后涎瘘;所有病例无味觉出汗综合征、无术后出血、无皮瓣坏死等并发症,随访24~48月,未见复发,手术切口疤痕不明显,美容效果满意.结论 腮腺上极良性肿物切除术应用耳后发际联合耳屏缘切口术式安全、可行,切口隐蔽.     

Wide excision of accessory parotid gland with anterior approach

Accessory parotid gland tissue has been described as salivary tissue adjacent to the Stensen duct that is distinctly separate from the main body of the parotid gland. Of all parotid gland tumors, 1% to 8% arise from the accessory parotid gland. Little is known about the accessory parotid gland, and it is seldom mentioned in the literature. Between 1999 and 2010, we have treated and followed 8 patients with tumors of the accessory parotid gland. There were 5 males and 3 females with a mean age of 35 years. They all presented with an asymptomatic cheek mass, and 4 of them underwent fine-needle aspiration. Ultrasound or computed tomographic scan was used in all patients. All the patients underwent surgical intervention with standard parotidectomy incision and anterior extension. The mean follow-up time was 44 months (range, 6-120 months). Seven patients had benign disease. Four cases were pleomorphic adenoma, and the remaining 3 benign cases were parotid cyst, basal cell adenoma, and hemangioma. Only 1 patient had a malignant tumor that was a lymphoepithelioma-like carcinoma. In 7 cases, wide excision (excision of mass and accessory lobe of the parotid gland) was done because of the intra-accessory parotid gland lesion. One patient had concomitant superficial parotidectomy because the tumor was located very close to and has involved the parotid gland proper. There was no serious postoperative complication and recurrence. Prudent preoperative diagnostic evaluation and meticulous surgical approach are the keys to successful management of midcheek lesions. A wide excision of the accessory lobe of the parotid gland can be a definitive surgery in case of solitary tumor with an intact parotid fascia, and wide excision with anterior approach through a standard parotidectomy incision is preferred to a direct incision over the mass.     

Resection of accessory parotid gland tumors through a peroral approach with facial nerve monitoring

Accessory parotid glands are an anatomic variation. Pathologic alterations, which occur in these tissues, are related to those found in the parotid gland. At this time, first-line therapy consists of total resection. In consideration of the delicate anatomy in this region, a careful approach through a lateral parotidectomy or a facelift incision is recommended. In this report, we give an account of a minimally invasive surgical alternative through a peroral approach with facial nerve monitoring. The histologically secured pleomorphic adenoma was completely removed. During surgery, a branch of the facial nerve was detected and secured with active nerve monitoring. We are confident that the peroral resection, supported by active and passive facial nerve monitoring, is a discussable alternative for well-selected tumors of accessory parotid glands.     

Unilateral parotid gland involvement with synchronous multiple Basal cell adenomas

Basal cell adenoma (BCA) is a rare benign epithelial tumor of the salivary gland. BCA is seen most frequently in the parotid gland and less commonly in the submandibular gland and minor glands of the upper lips, oral cavity, and hard palate. Salivary gland tumors are observed as single tumors in one salivary gland. Double or multiple tumors of the salivary gland tumors are unusual and metachronous or bilateral salivary gland tumors are more observed than synchronous or unilateral tumors. The most commonly seen multiple tumor unilaterally or bilaterally is the Warthin's tumor. A 65-year-old woman with a painful, slowly enlarging mass in front of the left ear, which was present for 6 months, was evaluated. Physical examination revealed two solid and well-delineated masses in the preauricular region, which were 1.5 x 1 cm in diameter and in the tail of the parotid gland, which is 2.5 x 2 cm in diameter. Excision of the superficial lobe of the parotid gland was performed. The macroscopic examination of the specimen showed the two discrete nodular masses. Histologic examination of the two nodular solid lesions was reported as BCA. Multiple synchronous nonmembranous-type BCAs of the unilateral parotid gland is a rare entity. More extensive excision of the parotid gland tumor, careful macroscopic perioperative examination of the surgical specimen, and histologic evaluation of all surgical specimens might be necessary for reducing revision operations and surgical complications.     

腮腺区良性肿瘤术后并发症发生的相关因素分析

目的： 探讨腮腺良性肿瘤术后各类并发症发生的相关因素。方法：搜集并整理我院2010—2015年手术治疗的215例腮腺良性肿瘤患者的病例资料,回顾分析一般资料、手术治疗中不同因素及术后并发症的发生情况。采用SPSS17.0软件包对资料进行χ2检验。结果：术后积涎或涎瘘、面神经功能障碍及Frey综合征的发生与手术治疗中不同因素（手术切口、术中是否缝扎腺体残端、面神经解剖方式、手术切除范围及是否行胸锁乳突肌瓣转移修复等）之间具有显著相关性（P＜0.05）。结论：“N”形切口在解剖形态上不利于术后常规引流渗出液,需配合负压引流管,以减少术后积涎的发生。缝扎腺体残端能有效避免术后积涎及涎瘘的发生。顺行法解剖面神经及腮腺肿瘤区域性切除能加快手术速度,减少面神经的解剖量及暴露时间,从而减轻术后面神经功能障碍的发生。胸锁乳突肌瓣的转移修复能很好避免术后Frey综合征的发生。     

Video-assisted resection in mediofacial lateral tumors

Tumors that developed into the soft tissues of the cheek rising from the anterior prolongation of the parotid gland, minor salivary glands, and the masseter muscle are the most profitable with the use of video-assisted surgery.In the Department of Plastic Surgery at Argerich Hospital in Buenos Aires, Argentina, from 1999 to 2010, video-assisted approaches were used in the treatment of 158 patients, 16 of them presented tumors that developed into the tissues of the cheek.Intraoral approach such as natural orifice surgery was performed in 13 cases; in the other 3 cases, a preauricular incision was performed. Minor complications such as hematoma and transitory paresis of the superior buccal nerve were detected.Video-assisted technique offers both good illumination and excellent magnification, permitting not only a safe anatomic dissection by means of surgical maneuvers in avascular planes but also contributed to avoid injuries of facial nerve branches and secondary obstruction of the Stensen duct. On the other hand, when intraoral incisions are used, visible scarring is avoided; the uses of transoral areas are the most feasible approaches of natural orifice surgery.The outcome achieved with endoscopic techniques in mediofacial lateral areas has permitted to consider it as the first election in the surgical treatment in tumors that developed into the soft tissues of the cheek, offering more advantages than the classic approaches.