Transmandibular Transpterygoid Approach to the Nasopharynx, Parapharyngeal Space, and Skull Base
Transmandibular Transpterygoid Approach to the Nasopharynx, Parapharyngeal Space, and Skull Base
复制标题
经下颌翼突入路进入鼻咽、咽旁间隙和颅底
DOI：
10.1177/000348949210100502
复制
发表时间：
1992
期刊：
影响因子：
--
通讯作者：
N. Yanagihara
中科院分区：
文献类型：
--
作者：
E. Yumoto;H. Okamura;N. Yanagihara
鼻咽、咽旁间隙上部和颅底对外科医生来说是相对不可触及的，没有重大的术后并发症。通过腭部和上颌窦的传统手术入路的手术范围太小，无法切除广泛的肿瘤。作者应用经下颌翼突入路切除5例鼻咽癌全剂量照射后残留肿瘤、1例鼻咽部多形性腺瘤和1例延伸至颈静脉孔的大型咽旁神经鞘瘤。该入路提供了广泛的手术范围，便于处理大血管和脑神经。所有肿瘤均顺利切除。2例良性肿瘤患者经治疗后均顺利康复。在五名鼻咽癌患者中，两人分别活了68个月和50个月，没有任何疾病的证据，两人死于肝脏和骨转移。另一名患者肺部转移瘤还活着。然而，在局部原发部位没有肿瘤复发。由于鼻咽癌病例的数量很少，手术切除放疗后残留的鼻咽癌的有效性尚不清楚。我们的经验证明，经下颌翼突入路是治疗鼻咽、咽旁间隙和颅底肿瘤性病变的一种实用方法。
The nasopharynx, upper part of the parapharyngeal space, and skull base are relatively inaccessible to the surgeon without major postoperative complications. Operative fields reached by conventional approaches through the palate and maxillary sinus are too limited and narrow to remove extensive tumors. The authors applied a transmandibular transpterygoid approach for the removal of five residual nasopharyngeal carcinomas (NPCs) after full doses of irradiation, one pleomorphic adenoma of the nasopharynx, and one large parapharyngeal schwannoma extending into the jugular foramen. This approach offers a wide operative field so that large blood vessels and cranial nerves can be managed easily. All tumors were successfully resected. Two patients with benign neoplasms had uneventful recoveries after treatment. Of five patients with NPC, two are alive with no evidence of disease for 68 months and 50 months, respectively, while two died of metastases to the liver and bones. The other patient is alive with metastases in the lungs. No tumor recurred in the local primary site, however. Since the number of NPC cases is small, the usefulness of surgical removal of the postirradiation residual NPC is not clear. Our experience proved that the transmandibular transpterygoid approach is a practical method in the treatment of neoplastic lesions in the nasopharynx, parapharyngeal space, and skull base.