翼腭窝、颞下窝肿瘤手术治疗

目的:回顾总结颞下窝、翼腭窝肿瘤的手术治疗的方法及效果。方法:2004～2007年我院翼腭窝、颞下窝肿瘤患者18例,其中良性肿瘤患者5例,恶性肿瘤患者13例。术前影像学检查判断肿瘤位置及良、恶性,选择手术进路、切除范围,酌情用组织瓣填充术腔,术后行放疗或化疗,随访3月～3年。结果:5例良性肿瘤患者随访6个月～3年,无1例复发。13例恶性肿瘤患者随访3个月～3年,生存期不足1年5例,生存期1.5～2年2例;6例生存期超过3年,且未见肿瘤复发、转移。结论:对翼腭窝、颞下窝肿瘤手术治疗应注意其诊断及手术方法特点。     

翼腭窝肿瘤手术方法的改良

目的:对改良Borbosa手术进路在原发或继发性翼腭窝肿瘤处理的疗效评价。方法：在Borbosa手术切口的基础上，把口内上颌结节的切口经翼下颌韧带外侧向下达磨牙后区，然后向前达尖牙处以更好地暴露翼腭窝。对利用该手术进路治疗原发性或继发性翼腭窝肿瘤患者9例进行了影像学检查分析。结果：9例患者中4例肿瘤原发于翼腭窝，其中2例继发性地侵犯上颌窦；2例肿瘤原发于上颌骨；2例原发于腮腺深叶；1例为颅外脑膜瘤。9例均进行了术后3个月～9年6个月的追踪，其中1例术后2年2个月复发。结论：改良的Borbosa手术进路对翼腭窝肿瘤或翼腭窝肿瘤扩展进入上颌窦是特别有用的。     

翼腭窝纤维黏液样梭形细胞瘤1例报告

翼腭窝是位于上颌窦后壁和蝶骨翼突前表面之间的一小块区域,很少有肿瘤原发于翼腭窝.本文报告1例罕见的发生于翼腭窝的纤维黏液样梭形细胞瘤,并探讨其手术方案、治疗及预后.患者为58岁女性,CT显示右侧翼腭窝区呈结节状低密度影,增强CT显示翼腭窝区强化,边界不清,相邻的上颌窦壁强化,且与强化区相邻的上颌骨和右侧肌肉受压迫.组织...     

翼腭窝神经阻滞麻醉的临床应用

通过对60个成人整颅、120个翼腭窝进行测量.发现翼腭窝有三种类型:第一种为锥体型,有63个(52.5%);第二种为窄隙型,有20个(16.7%);第三种为中间型,有37个(30.8%).自行设计了两个体表定位点即.颧骨点、眶外下点.测出了两点至翼腭窝内侧壁和后壁的距离.从临床麻醉需要提出了两种新的上颌神经和封闭翼腭神经节的麻醉方法,临床应用315例,完成口腔颌面部大中手术219例.结果显示:有效率295例(93.65%),显效20例(6.35%),无效0.笔者认为该方法在应用中,具有效果良好易掌握,无污染等优点.     

累及颅底的咽旁颞下区肿瘤手术入路选择

发生于颞下窝、咽旁间隙、翼腭窝、颞骨等处的肿瘤可原发，也可由邻近部位侵犯扩展而来。肿瘤向上发展可侵及颅义底甚至颅内。由于该解剖区域隐蔽、深在，四周以骨性结构为主，早期诊断困难，患者就诊时肿瘤往往已较大，尤其是原发于颅底或由他处侵犯扩展到该区甚至侵入颅内的肿瘤，治疗上还有许多困难。     

翼腭窝及翼腭窝邻近结构中良、恶性肿瘤的诊断与外科处理

翼腭窝区域的手术因为位置深在、解剖结构复杂,使得发生在该区域的肿瘤切除具有巨大的挑战性。当翼腭窝的肿瘤累及上颌骨、进入上颌窦,腮腺深叶的肿瘤扩展进入翼腭窝时,广泛的切除通常是必要的。随着影像学、病理诊断学、外科技术、手术器械和重建技术的进步,颅底外科已成为多学科外科医师关注的热点。本文就翼腭窝及翼腭窝邻近结构中良、恶性肿瘤的诊断与外科处理进行系统的论述。     

下颌切迹入路细针穿吸细胞学检查在面侧深部肿物诊断中的应用价值

目的:评价经下颌切迹入路的细针穿吸细胞学检查(FNAC)在面侧深部肿物诊断中的应用价值。方法:应用细针穿吸方法,对40例面侧深部肿物患者进行细胞学检查。男24例,女16例;年龄3～75岁,平均年龄43.28岁。将细胞学检查结果与术后组织病理学检查结果或随访资料进行比较,计算FNAC诊断准确率及在区别肿瘤与非肿瘤、恶性肿瘤与良性病变上的敏感度和特异度。结果:FNAC诊断准确率为80.00%;诊断肿瘤与非肿瘤的敏感度为80.77%,特异度为100.00%,5例患者为假阴性,假阴性率为19.23%,假阳性率为0;诊断恶性肿瘤与良性病变的敏感度为80.00%,特异度为88.00%。3例患者为假阴性,假阴性率为20.00%,3例患者为假阳性,假阳性率为12.00%。结论:FNAC是一种安全性好,操作简单,患者易于接受的诊断方法,在不易做切除及切取活检的面侧深部肿物的定性诊断中有较高的准确率,能准确区别肿瘤与非肿瘤、恶性肿瘤与良性病变,为临床治疗提供依据。     

翼腭窝的解剖学特点及其相关技术进展

翼腭窝是位于眶尖后下方、颞下窝内侧的一个狭小骨性间隙,窝内有丰富的血管、重要的神经等结构通过,众多起源于口鼻腔、眶内、颅中窝、颞下窝和鼻旁窦的病变均可累及此窝。本文总结了近年来翼腭窝的解剖学及其相关临床诊疗技术的研究进展。     

下颌骨外旋入路切除颞下窝肿瘤手术分析

目的：：分析颞下窝肿瘤下颌骨外旋手术入路的效果。方法：回顾11例下颌骨外旋入路切除颞下窝肿瘤的临床资料,5例在下颌骨颏孔前方截骨,4例在下颌角前截骨,2例在颏正中截骨。结果：下颌骨外旋入路根据肿瘤的性质、部位、大小及与周围神经血管的关系,灵活的选择下颌骨截骨部位,均可充分显露颞下窝肿瘤达到较好的切除效果。结论：下颌骨外旋入路是切除颞下窝肿瘤安全有效术式。     

Maxillary-fronto-temporal approach for removal of recurrent malignant infratemporal fossa tumors: Anatomical and clinical study

PurposeFor recurrent malignant tumors occurring in the infratemporal fossa, it is difficult to select a proper surgical approach. We explore the efficiency of a new approach for removal of recurrent malignant tumors involving the infratemporal fossa based on the measurement on three-dimension CT, observation of six cadaveric specimens, and our surgical experience.Materials and methodsThe distances between the surgical landmarks in the infratemporal fossa were measured using CT data to determine the safe distance. And anatomy observation was examined on 6 formalin-fixed cadaveric specimens. Data from seven patients with recurrent malignant infratemporal fossa tumors were retrospectively analyzed.ResultsThe mean distance of the medial pterygoid plate from the zygoma was 52.12 mm. The maxillary artery can be found between the deep surface of the condyle and the sphenomandibular ligament, with mean distance of 8.25 ± 3.22 mm to the inferior border of the capsule of the temporomandibular joint. All tumors got gross resection using the maxillary-fronto-temporal approach with minor complication.ConclusionsThe advantages of the new approach include adequate protection of facial nerve with extended operation field; the exposed temporal muscle could be used to fill the dead space. This technique is especially useful to remove recurrent malignant infratemporal tumors safely.     

Infrasellar craniopharyngioma originating from the pterygopalatine fossa with invasion to the maxillary sinus

Craniopharyngiomas that originate in the nasopharynx and sphenoid bone (known as infrasellar craniopharyngiomas) are rare and comprise only 5% of all craniopharyngiomas. The involvement of the maxillary sinus has been reported only twice. We present a very rare case that involved the maxillary sinus.     

Benign temporomandibular joint tumours with extension to infratemporal fossa and skull base: condyle preserving approach

This article introduces a modified surgical approach combining condylotomy with posterior disc attachment release for the resection of large non-malignant masses located in the infratemporal fossa and involving the skull base. This retrospective study included 14 patients treated at Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University between January 2010 and December 2016. Clinical evaluations (visual analogue scale (VAS) for pain, maximum inter-incisal opening (MIO), and complications) and radiological findings (magnetic resonance imaging (MRI) and computed tomography (CT)) were collected pre- and postoperatively. All patients had satisfactory surgical exposure and complete resection of the neoplasms. During an average follow-up of 54.8 months, no clinical or radiographic signs of recurrence were reported. MIO increased from 28 mm preoperatively to 35.4 mm postoperatively (P < 0.001). The pain VAS score changed from 5.4 preoperatively to 0.7 postoperatively (P < 0.001). Neural function was normal for all patients. Postoperative MRI and CT scans showed a satisfactory disc position and condyle morphology, with no resorption. Three-dimensional reconstruction of the postoperative CT scan also demonstrated healing of the skull base defects. The modified surgical approach combining condylotomy with posterior disc attachment release is suitable for the removal of large non-malignant masses involving the infratemporal fossa and skull base.     

颞下-耳前入路手术切除颅底颞下窝肿瘤四例报告

目的:探讨颅底颞下窝肿瘤切除的手术进路和手术方法.方法:根据肿瘤的性质和大小,对2003.10.～2008.2收治的4例颅底颞下窝良性肿瘤病例,采用颞下-耳前入路进行手术治疗.结果:4例病例手术后愈合良好,经6个月～3年随访无1例复发,未见有明显颜面部功能障碍.结论:颅底颞下窝肿瘤位置较深,难以发现,发现后往往瘤体较大,甚至已有颜面部功能障碍,对颅底颞下窝良性肿瘤采用颞下-耳前入路进行手术,肿瘤切除相对容易,风险小,安全,并能有效修复手术遗留的死腔.     

颞肌在翼腭窝肿瘤侵犯软硬腭术后缺损修复中的应用

目的评价翼腭窝肿瘤侵犯硬软腭术后组织缺损颞肌修复重建的效果。方法在1998年2月-2003年1月5年，共有11例患者接受手术治疗。11例患者中，男8例，女3例。年龄31—68岁，平均49．6岁。11例患者均为翼腭窝肿瘤侵及硬软腭者，手术均采用改良Barbosa联合侧颞部切口进路摘除肿瘤，术中遗留的硬、软腭缺损采用患侧前和中颞肌瓣修复。结果11例患者中，粘液表皮样癌4例，腺样囊性癌3例，骨肉瘤1例，低分化腺瘤2例，成釉细胞瘤1例。硬软腭缺损面积为30～50％，术后创面均一期愈合，肌瓣无坏死，4周后肌瓣口腔面粘膜化。术后患者进食与术前无差异，腭咽闭合无影响。结论使用颞肌瓣修复翼腭窝肿瘤侵犯硬、软腭术后缺损是一种有效的好方法。     

Endoscopic approach to the trigeminal nerve: An anatomic study

ObjectiveTo describe an endoscopic perspective of the surgical anatomy of the trigeminal nerve.MethodsNine adult cadaveric heads were dissected endoscopically.ResultsOpening the pterygopalatine fossa is important because many key anatomical structures (V2, pterygopalatine ganglion, vidian nerve) can be identified and traced to other areas of the trigeminal nerve. From the pterygopalatine ganglion, the maxillary nerve and vidian nerve can be identified, and they can be traced to the gasserian ganglion and internal carotid artery. An anteromedial maxillectomy increases the angle of approach from the contralateral nares due to an increase in diameter of the piriform aperture, and provides excellent access to the mandibular nerve, the petrous carotid, and the cochlea.ConclusionsIdentification of key anatomical structures in the pterygopalatine fossa can be used to identify other areas of the trigeminal nerve, and an anteromedial maxillectomy is necessary to expose the ipsilateral mandibular nerve and contralateral cranial level of the trigeminal nerve.     

前侧方入路至颞下窝及邻近区域的临床解剖研究

目的:探讨前、侧方入路显露颞下窝及邻近区域的优缺点。方法:选10例成人头部标本,模拟前、侧方入路分层解剖,对关键结构测量分析。结果:显露颞下窝的主要障碍是面神经,颧弓和下颌升支。前方入路能保留大部分结构的生理功能,完整显露颞下窝。而侧方入路受面神经的限制,只能局部显露。前方入路可通过处理上颌骨显露翼腭窝,侧方入路通过处理腮腺进入咽旁间隙。结论:前、侧方入路显露的侧重点不同,且各具优缺点。