Transoral Removal of Tumors of the Dorsal Aspect of the Soft Palate: A Technical Note
Transoral Removal of Tumors of the Dorsal Aspect of the Soft Palate: A Technical Note
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DOI：
10.1002/lary.29457
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发表时间：
2021-02
期刊：
影响因子：
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通讯作者：
Shintaro Nakamura;Hiroyuki Ozawa;Mariko Sekimizu;Yuichi Ikari;Nana Nakahara;Shin Saito;Keisuke Yoshihama;Y. Nishiyama;K. Ogawa
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文献类型：
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作者：
Shintaro Nakamura;Hiroyuki Ozawa;Mariko Sekimizu;Yuichi Ikari;Nana Nakahara;Shin Saito;Keisuke Yoshihama;Y. Nishiyama;K. Ogawa
前言鼻咽部可发生不同类型的肿瘤，其中良性肿瘤占60%，恶性肿瘤占40%。在这个解剖区域，竞争肿瘤的切除总是很困难的，因为鼻咽是一个被基本结构包围的小空间，如颈内动脉和咽鼓管。此外，鼻咽位于共同鼻道的远端，紧靠口腔中的软腭后方。良性肿瘤，如乳头状瘤，可能出现在这一区域，并引起诸如鼻塞、打呼、异常咽部感觉和鼻出血等症状。对于这类病例，肿瘤切除是必要的，但由于手术的解剖位置和侵袭性，切除有足够边缘的肿瘤总是具有挑战性的。鼻内窥镜手术是鼻咽部肿瘤合适的治疗选择。然而，良性鼻咽部肿瘤常常在没有足够切缘的情况下切除，有时甚至在内窥镜引导下零碎切除，导致肿瘤复发。鼻咽分为软腭部的后部、侧部和背部(DASP)。普通鼻道经常被用作切除位于后壁和侧壁的肿瘤的手术走廊，尽管口腔有时也可用于腺样体切除等手术。使用新技术的经口外科手术受到了挑战，但这些方法主要应用于鼻咽侧壁或后壁的肿瘤。同时，使用经鼻或经口途径接触DASP是极其困难的。已有报道采用悬雍垂腭咽成形术(UPPP)经口腔切除DASP肿瘤。然而，这种技术可能会导致腭咽闭合不全和吞咽困难。治疗DASP肿瘤需要一种侵入性较小的手术。在这项研究中，我们展示了一种新的手术技术，通过经口入路切除DASP肿瘤。使用柔性内窥镜显示肿瘤，并用弯曲的电刀切除肿瘤。
INTRODUCTION Different types of tumors can arise in the nasopharynx, of which 60% and 40% are benign and malignant tumors, respectively. Compete tumor resection is always difficult in this anatomical region, because the nasopharynx is a small space surrounded by essential structures, such as the internal carotid artery and eustachian tube. Moreover, the nasopharynx is located at the far end of the common nasal meatus and immediately behind the soft palate in the oral cavity. Benign tumors such as papillomas may arise in this area, and cause symptoms such as nasal obstruction, snoring, abnormal pharyngeal sensations, and epistaxis. Tumor resection is essential for such cases, but excision of the tumor with adequate margins is always challenging because of the anatomical location and invasive nature of surgery. Endoscopic surgery is a suitable treatment option for nasopharyngeal tumors. However, benign nasopharyngeal tumors are often excised without adequate margins, sometimes piecemeal, even under endoscopic guidance, resulting in tumor recurrence. The nasopharynx is classified into the posterior, lateral, and dorsal aspects of the soft palate (DASP). The common nasal meatus is often used as the surgical corridor for the excision of tumors located in the posterior and lateral walls, although the oral cavity may also be used sometimes for procedures such as adenoidectomy. Transoral surgery using new technologies has been challenged, but those approaches are applied mostly to tumors arising from the lateral or posterior wall of the nasopharynx. Meanwhile, the DASP is extremely difficult to access using the transnasal or transoral approach. Transoral resection of tumors of the DASP using the uvulopalatopharyngoplasty (UPPP) procedure has been reported. However, this technique can cause velopharyngeal insufficiency and dysphagia. A less invasive procedure is required for treating DASP tumors. In this study, we demonstrated a novel surgical technique for resecting tumors of the DASP using the transoral approach. The tumors were visualized using a flexible endoscope and removed with a curved electric scalpel.