不同下颌骨截骨方式在咽相关区域肿瘤手术中的应用

目的 探讨不同下颌骨截骨方式在咽相关区域暴露及肿瘤切除手术中的适应证.方法 回顾性分析2006年1月至2013年12月采用下颌骨截骨方式切除咽相关解剖区域肿瘤23例,其中应用下颌骨正中截开7例,下颌骨角部截开6 例,单纯下颌骨方块或“L”型截骨5例,下颌骨升支纵行截开5例.结果 运用4种下颌骨截骨方式,术野暴露满意,均完整切除肿瘤,恶性肿瘤切缘均为阴性;12例患者术后给予放疗或同步放化疗,均未出现放射性骨髓炎.所有患者术后下颌功能恢复良好,张口度及咬合达到理想要求.结论 咽相关区域复杂肿瘤手术时根据肿瘤原发位置、性质及大小,灵活机动地采取不同的下颌骨截骨方式,不仅可以获得良好的术野和肿瘤切除的安全界限,也可以较好地满足一期修复及口颌系统功能恢复的要求.

Applications of different mandibulotomy approaches to the resection of pharyngeal region tumors

Objective To discuss the indications of different mandibulotomy approaches for the exposure and resection of tumors in the pharyngeal region. Methods A retrospective analysis was presented for 23 resection of pharyngeal region tumors between January 2006 and December 2013. The mandibulotomy included the middle of the corpus mandibulae osteotomy (7 cases), the angulus mandibulae osteotomy (6 cases), pure block or “L” shape corpus mandibulae osteotomy (5 cases), and through vertical corpus mandibulae osteotomy (5 cases). Results The operation visual fields were sufficient. The operations were completed smoothly and successfully.The cutting edge of malignant tumors were all negative. Twelve patients were treated with postoperative radiotherapy or radiotherapy companied by chemotherapy, and radioactive osteomyelitis did not occur. All patients' mandibular function recovered well and the degree of mouth opening and occlusion met the ideal requirements. Conclusion Different mandibulotomy approach should be chosen according to the primary tumor location, nature, and size. To take different approaches flexibly can not only acquire a good operative field but also meet the demand of one stage repairment and recovery of stomatognathic system function.