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。

Diagnosis and Surgical Management of Tumors in the Parapharyngeal Space and Infratemporal Fossa

Objective:To discuss the clinical manifestations, diagnostic methods, and surgical approaches in the treatment of tumors in the infratemporal fossa and parapharyngeal space. Methods: The clinical data including Contrast-enhanced CT and MRI images of 15 patients, with infratemporal fossa or parapharyngeal space tumors operated from 2010 to 2014, were retrospectively reviewed. According to the different incision approaches, there are 3 subtypes: ① lateral neck ap-proach;②lateral neck plus the mandibular osteotomy approach;③anterior tragus incision. Results:Tumors were excised en bloc from those 15 patients. All cases had been followed up at least 1 year. No recurrences were found in 13 cases of benign tumors, the 3-and 5-year disease-free survival rate of 2 cases of malignant tumors were 100%. Conclusion: Even though Contrast-enhanced CT and MRI are effective preoperative diagnostic methods for infratemporal fossa or parapharyn-geal space tumors, the characteristics of surgical anatomy should be in key considerations. Since the soft tissue of neck has fantastic flexibility, small sized parapharyngeal space tumors could easily excised through lateral neck incision. While for those tumors located in the deep anatomic site or adherent to the nearby soft tissue, lateral neck plus mandibular osteoto-my approach or anterior tragus incision should be considered.