上颌骨全切除术改良的手术径路

目的　根据上颌骨解剖学上的特点 ,结合各类手术径路的优点 ,设计一种改良的上颌骨全切除术的手术径路 ,旨在改善术后的外形与功能。方法　共有 17例患者采用了该上颌全切除术的手术径路 ,即 :切口设计在下唇 ,沿颏面沟与颌下、腮腺耳前切口连接至同侧发际。切口设计依据为避开上颌区 ,隐蔽切口位于面颌部正常的皮肤皱折区 ,术中对面神经下颌缘支、下颊支、颏神经、腮腺导管以及内眦部等均加以保存。其中行上颌骨全切除 14例 ,次全切除 3例。结果　经 1～ 12个月术后随访 ,疗效满意。其中 11例术后放疗患者均未出现任何皮肤坏死及下颌水肿。因保存了面神经下颌缘支和下唇肌支 ,仅 1例发生轻度口角歪斜畸形。结论　本文提出的上颌骨全切除术改良的径路 ,能充分暴露并完整切除上颌骨肿瘤 ,术后有较满意的外形及功能 ,可作为上颌骨全切除的一种常规手术径路。若病变超过上颌骨区的范围 ,则不应采用本文介绍的手术径路

A MODIFIED SURGICAL APPROACH OF FULL MAXILLECTOMY

Objective A modified approach of full maxillectomy is designed to overcome the drawbacks of common Weber Fergusson line. It is based on anatomic characteristics of maxilla and meet the advantages of various common excision lines, as to improve both post operative contour and function.Methods From July 1998 to July 1999, there are 17 cases underwent full maxillectomy upon this new approach, in which the excision line is coming the lower lip and the facial chin glove. Then it goes along with the mandibular margin and links up the anterior articular parotid gland line and tills the same lateral hair boundary. This excision line is designed to avoid maxilla area cutting and lie concealed margin at maxillofacial skin wrinkle. The submandibular and sub buccal branches of facial nerve and the nerve of chin could be preserved with salivary duct and angulus oculi medialis at surgery.Results Satisfied result was acquired at fellow up from one month to one year. Among these cases, 11 patients who received radiotherapy post operatively had not the skin necrosis or edema. Their facial nerve was remained completely except for one case's slight askew of mouth.Conclusion This new surgical excision line design can expose clear enough to perform full maxillectomy with the advantages of satisfactory contour and function post operatively but except the situation when tumor surpasses the maxilla region.