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。     

咽旁颞下窝肿瘤的外科治疗及局部临床解剖学研究

目的研究咽旁颞下窝的解剖结构及毗邻关系,为咽旁颞下窝肿瘤选择合适的手术入路及手术方法提供解剖学依据,以减少并发症的发生。方法利用9个经10％福尔马林固定的国人成人头颅标本,对咽旁颞下窝相关解剖进行观察、摄像,同时结合7例临床咽旁颞下窝肿瘤患者,结合术前影像学检查,行耳前、下颌下切口手术切除肿瘤。结果以翼外肌上下头为参照,其浅及深面有重要的血管、神经分布。7例患者手术顺利,无术后并发症。术后随访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,淖纯耳前、下颌下切口可完全顺利切除肿瘤。熟知咽旁颞下窝的解剖层次可明显减少手术创伤及预防手术并发症的发生。     

69例鼻咽癌侵犯颅面部解剖结构的CT影像分析

目的：采用CT影像分析鼻咽癌对颅面部组织的侵袭特点。方法：分析69例鼻咽癌首次放疗前的CT影像,分别统计其向前方(包括翼板、翼腭窝、上颌窦、筛窦、鼻腔)、外侧方(包括腭肌、咽旁间隙、颈鞘、颢下窝)、内侧方(鼻咽腔、对侧鼻咽)、后方(包括椎前肌、颈椎、斜坡)、上方(包括蝶窦、破裂孔、卵圆孔、蝶骨大翼、岩尖、颅内)、下方(口咽侧壁、口咽旁间隙、软腭、硬腭)侵犯的比例。结果：本组向前侵犯18例,占26．1％：向外侧侵犯53例,占76．8％;向内侧侵犯31例,占44．9％;向后侵犯32例,占46．4％：向上侵犯14例,占20．3％;向下侵犯29例,占42．0％。结论：向外侧方侵犯是鼻咽癌最常见的侵犯方向,其次是向后方侵犯,其后依次是内侧方、下方、前方、上方。     

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。     

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。     

咽旁颞下区肿瘤的诊断和手术治疗体会

目的:探讨位于颞下窝、咽旁间隙肿瘤的临床表现及诊断方法 ,分析颈侧入路及耳屏前入路的手术疗效,总结治疗心得体会。方法:回顾分析2010—2014年间,15例颞下窝、咽旁间隙肿瘤患者临床资料,包括影像学、组织学检查,分别采用单纯颈侧入路、颈侧入路+下颌骨劈开外旋术或耳屏前切口入路方式切除肿瘤。结果:15例患者均完整切除肿瘤,术后随访1~5年,13例良性肿瘤均无复发,2例恶性肿瘤患者无瘤生存3~5年。结论:术前行增强CT和MRI可明确颞下窝、咽旁肿瘤占位及大小,对手术方案的制定有一定帮助,但不应完全依照影像学检查结果实施手术。利用颈侧软组织可让性,能有效切除咽旁间隙体积较小的肿瘤。对于位置较高且粘连较重的良性肿瘤及侵袭性较强的恶性肿瘤,可考虑采用"颈侧入路+下颌骨劈开外旋术"或"耳屏前切口入路+颧弓切断术"切除。     

切除翼上颌及颅中窝底肿瘤的一个新手术进路(5例报告)

目的　介绍切除翼上颌及颅中窝底肿瘤的一个新手术进路。方法　从上唇红唇向上达患侧鼻孔底 ,然后向外绕鼻翼向上达内眦 ,向外达耳屏前向上作半冠状切开。向下及向中线在骨膜下分别翻转颊瓣及头皮瓣。截除上颌骨、眶下及额颞颅底之颅骨后 ,肿瘤完全暴露 ;摘除肿瘤后 ,用微型夹板固定骨块。分层缝合复回之组织瓣。结果　可获得从对侧咽鼓管到同侧膝状神经节 ,包括鼻咽、斜坡、蝶窦、翼静脉丛及颞下窝和眶上裂在内的良好暴露。用本进路对 5例患者进行了治疗 ,全部一期愈合。结论　本进路对包括鼻咽、斜坡、眶上裂、颞下窝及翼腭窝在内的肿瘤病变特别有用。     

Ipsilateral keratoconus associated with long-standing primary hydatid cyst of the orbit

Hydatid cyst is a cyclozoonotic infection of the larvae form of a platyhelminthes Echinococcus granulosus. The majority of hydatid cysts appear in the liver (65%) and lungs (25%). Kidneys and brain are other less common sites for this disease. Only 1% to 2% cases are seen in the maxillofacial region. These commonly appear as cystic lesions located in the mandible, maxillary sinus, orbit, infratemporal fossa, pterygopalatine fossa, parapharyngeal space, tongue, and parotid and submandibular salivary gland. Hydatid cysts of the orbit are rare and account for 1% of all hydatid cysts. The article presents hydatid cyst of the orbit in a 10-year-old child. Clinical features, investigations, surgical approaches, and adjuvant medical management have been emphasized. We believe that the lateral orbital route allows excellent exposure and safe removal of an intraorbital hydatid cyst located posteriorly, superiorly, and laterally without damaging the surrounding important orbital structures. Upper blepharoplasty incision results in good cosmetic outcome.     

The clinical anatomy of the maxillary artery in the pterygopalatine fossa.

PURPOSE: The purposes of this study were to delineate the maxillary artery and its branching arteries and to develop a classification of the various branching patterns by means of serial cadaver dissections of the pterygopalatine fossa region. MATERIALS AND METHODS: Fifteen Korean adult cadavers were used; 2 sides of each cadaver were examined, for a total of 30 sides. Before dissection of the pterygopalatine region, computed tomography scan was taken of 20 cadaver heads. Sectioned specimens of 9 sides of the cadaver heads in 3.0-mm thickness were made for this study. Then we dissected 21 sides of fresh cadavers under the microscope. In this investigation, we observed branching patterns of the third portion of the maxillary artery, a relationship of the terminal branches of the maxillary artery to the pterygomaxillary junction, and the course of descending palatine artery. Then we classified the branching patterns of the maxillary artery in the pterygopalatine fossa. RESULTS: From the pterygomaxillary junction to the pterygopalatine fossa region, the maxillary artery was usually branched into 5 arteries in the following order: posterior superior alveolar artery, infraorbital artery, artery of the pterygoid canal, descending palatine artery, and sphenopalatine artery. Of 21 cadavers, 18 showed this order (85.7%). There were 2 types of branching patterns of the posterior superior alveolar artery and the infraorbital artery. The average distance from the most inferior point of the pterygomaxillary junction to the posterosuperior alveolar artery, infraorbital artery, and descending palatine artery was 15.2, 32.2, and 24.8 mm, respectively. In most cases (95.2%), the greater and lesser palatine arteries were divided from the short descending palatine artery. According to the contours of the third portion of the maxillary artery, we classified them into 5 types: the "Y" type (19%), "intermediate" type (33.3%), "T" type (23.8%), and "M" type (14.3%). CONCLUSION: The results of this investigation show the common patterns of the maxillary artery.     

颅外原发性病变破坏颅中窝底的CT表现

目的 评价颅外原发性病颅中窝底的ＣＴ表现特点。方法 将４９例经病理证实的破坏颅中底的颅外的发病变分为两组;颅中窝底原发骨性病变;１０例;颌面部原发病变;３９例。结果 颅外病变破坏颅中窝底的方式有４种;（１）骨吸收（３０例）,包括１６例颅中窝底外板吸收和１４例内外板均吸收;（２）颅中窝底硬化增厚（４例）;（３）圆孔和卵圆孔扩大（９例）;（４）硬化和吸收并存（６例）。受累的颅内结构：海绵窦１２例,颞叶     

Attenborough与改良Barbosa手术进路对翼腭窝肿瘤暴露与术后功能影响的研究

目的：对比Attenborough 与改良Barbosa 手术进路对翼腭窝肿瘤暴露与术后功能的影响。方法：本组选发生翼窝的肿瘤患者15例为研究对象，患者术前行MRI检查确定肿瘤的部位、范围及与周围组织的关系，按MRI显示的病变范围不同选择Attenborough或改良Barbosa 手术进路暴露病变区域并切除肿瘤。术后观察功能影响情况。结果：原发于翼腭窝的肿瘤患者4例，1例采用Attenborough手术进路，3例采用改良Barbosa 手术进路；继发性翼腭窝肿瘤11例，5例源于腮腺深叶的肿瘤均采用Attenborough手术进路，另6例选用改良Barbosa 手术进路。Attenhorough手术6例，术后患侧腮腺颌区明显凹陷，5例口干，2例患者额纹消失，1例患者不唇歪斜。改良Bar-bosa手术9例，6例患侧颊部凹陷，6例患者中5例行赝复治疗；另3例术后无畸形。术后观察3个月-9年6个月，14例无复发，1例术后2年2年月复发。结论：临床应用结果证实Barbosa手术进路应用于翼腭窝肿瘤优于Atten-borough手术进路。     

Three-dimensional positional assessment of glenoid fossae and mandibular condyles in patients with Class II subdivision malocclusion

Objectives:To test the null hypotheses that the positions of the glenoid fossae and mandibular condyles are identical on the Class I and Class II sides of patients with Class II subdivision malocclusion.Materials and Methods:Retrospective three-dimensional (3D) assessments of the positions of the glenoid fossae and mandibular condyles were made in patients with Class II malocclusion. Relative to a fiducial reference at the anterior cranial base, distances from the glenoid fossae and condyles were calculated in pretreatment cone beam computed tomographic scans of 82 patients: 41 with Class II and 41 with Class II subdivision malocclusions. The 3D distances from glenoid fossae to sella turcica in the X (right-left), Y (anterior-posterior), Z (inferior-superior) projections were calculated.Results:Patients with Class II malocclusion displayed a symmetric position of the glenoid fossae and condyles with no statistically significant differences between sides (P > .05), whereas patients with Class II subdivision showed asymmetry in the distance between the glenoid fossae and anterior cranial base or sella turcica (P < .05), with distally and laterally positioned glenoid fossae on the Class II side. (P < .05). Male patients had greater distances between glenoid fossae and anterior cranial fossae (P < .05). The condylar position relative to the glenoid fossae did not differ between the two malocclusion groups nor between males and females (P > .05).Conclusions:The null hypotheses were rejected. Patients with Class II subdivision malocclusion displayed asymmetrically positioned right- and left-side glenoid fossae, with a distally and laterally positioned Class II side, although the condyles were symmetrically positioned within the glenoid fossae.     

Synovial chondromatosis of the temporomandibular joint with middle cranial fossa extension

Synovial chondromatosis of the temporomandibular joint (TMJ) is relatively rare. An unusual case with extension through the glenoid fossa and into the middle cranial fossa is reported. Invasion of the infratemporal fossa and the middle cranial fossa was seen on both computed tomography and magnetic resonance imaging. Complete removal of the loose bodies with excision of the affected synovium is the accepted treatment of synovial chondromatosis. A conservative approach should be followed while trying to eliminate any remaining lesion in the infratemporal fossa and the middle cranial fossa. An overview of previously reported cases of synovial chondromatosis with cranial extensions is also presented.     

Evaluation of structural skeletal asymmetry of the glenoid fossa in adult patients with unilateral posterior crossbite using surface-to-surface matching on CBCT images

ObjectivesTo compare, using surface-to-surface (StS) matching, any shape differences between the crossbite and noncrossbite side of the glenoid fossa and articular eminence in adult patients affected by posterior unilateral crossbite (PUXB) and compare them with unaffected controls.Materials and Methods32 cone beam computed tomography (CBCT) scans of patients (mean age: 23.72 ± 3.74 years) undergoing surgical maxillary expansion were analyzed to obtain three-dimensional models of the left and right glenoid fossae that were superimposed using stable anatomical reference points and then compared using StS matching to evaluate the presence of any shape differences. These findings were compared with those obtained from 16 CBCT scans of unaffected controls (mean age: 23.72 ± 3.73 years).ResultsA mean difference of >11% was found between the study group and controls when comparing the matching percentages of the two sides of the glenoid fossa and articular eminence at all three levels of tolerance selected for this study. These differences were found to be highly statistically significant (P ≤ .0001).ConclusionsAccording to the shape analysis findings, adult PUXB patients exhibit a higher degree of glenoid fossa and articular eminence shape differences compared to unaffected controls.     

44例颞下咽旁间隙肿瘤的临床和治疗

颞下咽旁间隙肿瘤患者４４例。良性肿瘤３１例，起源最多是腮腺深叶，其次是神经鞘膜；恶性肿瘤１３例，种类繁多。临床主要表现为咽侧壁膨隆；大多数病人是一种多样化、无痛性肿胀，少数病人出现发音改变和吞咽困难。全部病例获手术治疗。其中４１例获随访结果，随访时间最长２０年，作者就颞下咽旁间隙肿瘤的临床表现、诊断和手术等问题进行了讨论。     

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。     

Image features of aspergillosis arising from the pterygopalatine fossa: a case report and literature review

Aspergillosis of the skull base is an unusual disease entity, mainly found in immunocompromised patients. Aspergillosis originating in the pterygopalatine fossa (PPF) without contiguous spread from the sinuses is extremely rare. A 79-year-old woman complained of having suffered pain in her left cheek and headaches for 4 months. Computed tomography (CT) scans revealed soft tissue filling the left PPF with sclerotic change and erosion of the adjacent bone. A follow-up CT scan 1 month later after supportive care showed an increase in the extent of the soft tissue lesion in the left PPF with progressive erosion of the posterior wall of the left maxillary sinus. Magnetic resonance imaging revealed a low-signal-intensity mass in the PPF on T2-weighted images; the mass displayed strong enhancement on contrast-enhanced T1-weighted images and extended into the left maxillary sinus, infratemporal fossa, and cavernous sinus. The patient underwent a Caldwell-Luc operation with debridement of the PPF; the histopathological diagnosis was aspergillosis. The patient eventually died from cerebral ischemic change and brain edema during the postoperative period.     

Sequential changes of postoperative condylar position in patients with facial asymmetry

Objective:To evaluate sequential images of the condylar position in relation to the glenoid fossa after orthognathic surgery in patients with facial asymmetry using cone beam computed tomography.Materials and Methods:A total of 20 adult patients (11 men and 9 women; mean age, 22.1 ± 4.02 years) with facial asymmetry who underwent sagittal split ramus osteotomy with rigid fixation were involved. Cone beam computed tomography scans were obtained before treatment (T0), 1 month before the surgery (T1), and 1 day (T2), 3 months (T3), 6 months (T4), and 12 months (T5) after the surgery. The condyle position was evaluated.Results:At 1 day after surgery (T2), the condylar position on both sides significantly changed posteriorly, inferiorly, and laterally, but no significant difference was observed between the nonaffected and affected sides. The condyle on the nonaffected side had a tendency to recover its preoperative position at 3 months after surgery (T3) and inclined slightly laterally up to 1 year after the surgery (T5). The condyle on the affected side returned more closely to the glenoid fossa than to its pretreatment position at 3 months after surgery (T3). Thereafter, it showed a more backward and downward position (T5).Conclusions:The overall condylar position after an orthognathic surgery in patients with facial asymmetry was relatively stable at 1 year after surgery. However, the condyle on the affected side during the first 3 months after surgery should be carefully monitored for surgical stability.     

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.