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。     

颅底咽旁区肿瘤的外科治疗

本文报告了经外科手术治疗的51例颅底咽旁区肿瘤的体会，此区肿瘤可原发于肌肉、神经等组织，也可继发于上、下颌骨和腮腺等处。作者结合临床航此区肿瘤的特点、手术经路的选择、翼腭窝肿瘤的手术方法等问题进行了讨论。     

咽旁肿瘤36例临床分析

<正> 软腭、磨牙后区、颌后窝及上颈侧部肿块均可延伸到咽旁间隙,形成口咽侧壁膨出隆起。由于肿瘤的原发部位及组织来源不同,临床上表现的体征及症状亦可各有不同,该处位置深、间隙组织疏松,肿瘤可发展到相当大,常因自觉症状不明显而不被发现。治疗前要明确肿瘤性质、范围、组织来源才能较确切的制定治疗方案及手术进路,为了总结经验进一步     

咽旁颞下区肿瘤的手术治疗探讨

目的探讨咽旁颞下区肿瘤的有效诊治途径。方法回顾2003—2006年我科手术治疗咽旁颞下区肿瘤11例。手术采用颌下进路和耳前颌下进路,恶性肿瘤术后行放疗或化疗。结果11例患者10例手术患者肿瘤肉眼下全切除,1例放弃手术。术后病检:良性肿瘤2例,恶性肿瘤9例。结论①CT扫描和术中冰冻活检可有效指导手术治疗咽旁颞下区肿瘤。②颌下进路是该区肿瘤较好的手术途径,在累及腮腺、下颌升支的恶性咽旁颞下区肿瘤切除术中采用耳前颌下进路联合下颌升支切除中效果好。     

CT对咽旁肿瘤手术的指导意义

ＣＴ对咽旁肿瘤手术的指导意义滨州医学院口腔颌面外科（２５６６０３）杨佑成，李爱云位于咽旁间隙的肿瘤是口腔颌面外科治疗中的难题，为此我们结合ＣＴ对１３例咽旁肿瘤患者进行检查，对提示手术进路和提高手术的安全性方面有着重要意义。临床资料本组患者共１３例；男...     

累及咽旁颞下间隙肿瘤的诊断与治疗：附110例临床病例分析

文章对累及咽旁颞下间隙肿瘤１１０例进行了回顾性分析。作者以双侧乳突尘及上凳结节所形成之水平平面和茎突 舌骨肌前缘所形成之斜行冠状平面将该间隙分为下、下、前、后四个区段，并以四个区段为基础为累及该部位的肿瘤来源，临床表现，手术进路等进行了讨论。文章还对原发与继发两类肿瘤的发病，某些肿瘤间的鉴别，ＣＴ扫描等在该区肿瘤诊断和治疗上的重要性提出了自己的见解。     

咽旁颞下区的外科解剖钥匙———茎突

目的 研究茎突毗邻关系，为咽旁颞下区手术提供外科解剖基础。方法 测量颅骨。结果 茎突根部深面有颈静脉孔，两者相距约３ｍｍ。颈静脉孔前有动脉管外口，分隔两者间的骨板下缘厚约１．８７ｍｍ。在颈动脉管外口前外方有蝶骨角棘，二者相距约６．５ｍｍ。角棘之外侧有颞下颌关节窝，之前方为棘孔。棘孔之前内侧有卵圆孔。结论 茎突可作为咽旁颞下区的外科解剖钥匙。     

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。     

咽旁颞下区的外科解剖钥匙──茎突

目的研究茎突毗邻关系，为咽旁颞下区手术提供外科解剖基础。方法测量颅骨。结果茎实根部深面有颈静脉孔，两者相距约3mm。颈静脉孔前有动脉管外口，分隔两者间的骨板下缘厚约1．87mm。在颈动脉管外口前外方有蝶骨角棘，二者相距约6．5mm。角棘之外侧有颞下颌关节窝，之前方为棘孔。棘孔之前内侧有卵圆孔。结论茎突可作为咽旁颞下区的外科解剖钥匙。     

Solitary fibrous tumours of the infratemporal fossa. Two case reports

INTRODUCTION: The solitary fibrous tumour is a rare neoplasm originally described as a pleural tumour. An increasing number of different locations are described in the literature. Among the extrapulmonary sites, head and neck can be involved and particularly the nose, the paranasal sinuses, the submandibular region, the parapharyngeal space and the infratemporal fossa. MATERIAL: Two cases, one of a young woman and another of an elderly gentleman are reported, each presenting with a solitary fibrous tumour of the infratemporal fossa. In one case an antero-lateral, transcranio-facial and in the other, a transmandibular approach (without labiotomy) were utilized. In both cases complete excision of the lesion and good cosmetic results were achieved. RESULTS: Both patients were free from the disease for 5 postoperatively. CONCLUSIONS: To date, very few cases of solitary fibrous tumour of the craniofacial complex have been observed to enable an accurate prognosis. Thus, treatment and follow-up should be identical to fibrous tumours located in other areas.     

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.     

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。     

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。     

侵犯翼腭窝、颞下窝肿物的内镜手术入路选择

目的 探讨在侵犯翼腭窝、颞下窝肿瘤中选择内镜手术入路,为根据肿瘤性质和侵犯程度选择手术入路提供依据。方法 回顾分析第四军医大学西京医院2010年1月—2014年8月收治的50例侵犯翼腭窝或颞下窝并行内镜切除手术的肿瘤患者的临床资料,所有患者术前均行CT和MRI检查,根据肿瘤侵犯的方式和性质制定手术方案,选择手术入路。术后常规随访及影像学检查。重点评估不同入路的显露范围,安全手术的可能性,肿物全切率,以及术中、术后并发症。结果 经内镜手术治疗侵犯翼腭窝、颞下窝肿瘤50例,其中恶性肿瘤11例,包括腺样囊性癌5例,恶性成釉细胞瘤2例,软骨肉瘤2例,神经纤维肉瘤1例,恶性神经鞘膜瘤1例;良性肿瘤31例,鼻咽纤维血管瘤24例,神经鞘瘤5例,脊索瘤2例;囊肿8例,其中牙源性囊肿5例,表皮样或皮样囊肿3例。根据肿物侵犯范围,采用3种内镜下手术入路。内镜下经鼻腔入路27例,其中经中鼻道20例,经泪前隐窝7例;内镜下经柯-陆上颌窦入路9例;内镜下经鼻联合经柯-陆上颌窦入路14例。所有手术均能彻底切除肿物。随访时间6~55个月,平均34.3个月,3例失访,3例恶性肿瘤出现复发和远处转移。良性肿瘤和囊肿均无复发。结论 翼腭窝、颞下窝肿瘤在临床上并不少见,根据肿物的生物学特点、侵犯方式和范围选择恰当的手术入路,可以切除病变,降低并发症,减少手术创伤。     

Osteotomy in the vertical ramus outside the mandibular foramen for tumours in the parapharyngeal space

IntroductionAlthough several techniques have been described to access the parapharyngeal space, tumour surgery in this area remains a challenge. This study investigated a simple and safe technique to access parapharyngeal space tumours.Material and methodsEight primary parapharyngeal space tumours were treated with osteotomy of the vertical ramus outside the mandibular foramen. The primary tumours were pleomorphic adenoma, schwannoma, Warthin's tumour, lipoma, chordoma, and adenoid cystic carcinoma. Tumour size ranged from 4 × 4 cm to 6 × 7 cm. Patients with malignant tumours who underwent surgical resection also received adjuvant dose-fractionated stereotactic radiotherapy.ResultsAll tumours were removed completely without rupture. No patient exhibited any permanent postoperative complication, malocclusion, or other dental complications from this surgical approach. One patient had slight transient postoperative facial paresis, which resolved spontaneously within 4 weeks. The patients were followed for 7–26 months, during which no recurrence was encountered.ConclusionsOsteotomy of the vertical ramus outside the mandibular foramen achieved good exposure and satisfactory aesthetic and functional results. This simple and safe technique facilitates the removal of infratemporal fossa tumours while preserving the inferior alveolar nerve.