先天性耳颈瘘管的手术治疗

目的：进一步认识先天性耳颈瘘管的解剖异常特征和临床表现,并探讨该病的外科治疗方法.方法：回顾性分析21例先天性耳颈瘘管患者的临床资料,均采用手术治疗.结果：21例患者疗效满意,无腮腺瘘、面瘫及外耳道狭窄等并发症发生.结论：对该病的充分认识有利于早期诊断,完整地切除是治愈该病的惟一选择.腮腺的充分暴露及面神经的解剖与保护是完整切除瘘管及避免并发症发生的关键因素.

Surgical treatment of first branchial cleft anomaly

Objective:To identify the clinical and anatomical presentations and to discuss the guidelines for surgical mangement of anomalies of the first branchial cleft.Method:Twenty-one patients with first branchial cleft anomalies were treated in our department between Januany 1994 and December 2004, their clinical data were retrospectively analysed.Result:Surgery was performed on all patients.Among them 13 were males and 8 females, ranging in age from 1.5 to 33 years with an average of 15 years.Anatomically, 3 types of first branchial cleft anomalies were identified: fistulas(n=17),cysts (n=2),and fistula combined with cyst(n=2).Before definitive surgery,soma patients(n=4)underwent incision and drainage for infection owing to the difficulties in diagnosing this anomaly.Methylthioninium Chloride was used in almost all cases for tracking the fistulus during operation.Wide exposure is necessary in many cases,and a standard parotidectomy incision allows adequate exposure of the anomaly and preservation of the facial nerve.Conclusion:Complete removal without complications depends on a good understanding of regional embryogenesis,an awareness of the different anatomical presentations, and a readiness to identify and protect the facial nerve during resection.