El Morsy S M, Khafagy Y W
Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Egypt. shawky_morsy2003@yahoo .com
J Laryngol Otol. 2011 Jul;125(7):701-5. doi: 10.1017/S0022215111000673.
Surgical approaches to the pterygopalatine and infratemporal fossae are complex and cause significant morbidity. The commonest benign tumour to extend to the pterygopalatine and infratemporal fossae is angiofibroma.
This prospective study included 15 male patients aged 12-27 years with recurrent, severe epistaxis. After computed tomography and magnetic resonance imaging, a modified Wormald and Robinson's two-surgeon approach was used. Follow up, with endoscopy and magnetic resonance imaging, ranged from two to five years.
Twelve patients were cured (endoscopically and radiologically). Three patients suffered recurrence, one each in the lateral sphenoid wall, pterygoid canal and infratemporal fossa. Revision surgery was performed, but one patient suffered another recurrence (lateral sphenoid wall with cavernous sinus infiltration) and was referred for gamma knife surgery.
This endoscopic two-surgeon technique is an excellent approach for managing angiofibroma extending to the pterygopalatine and infratemporal fossae. Our modification markedly decreased morbidity by avoiding septum opening and sublabial incision, and by enabling better haemostasis (via maxillary artery control). Recurrence may be minimised by careful examination of the lateral sphenoid wall, pterygoid canal and infratemporal fossa pterygoid muscles.
翼腭窝和颞下窝的手术入路复杂，且会导致明显的发病率。最常累及翼腭窝和颞下窝的良性肿瘤是血管纤维瘤。
这项前瞻性研究纳入了15名年龄在12至27岁之间、患有复发性严重鼻出血的男性患者。在进行计算机断层扫描和磁共振成像后，采用了改良的沃尔默德和罗宾逊双术者入路。随访采用内镜检查和磁共振成像，时间为2至5年。
12名患者治愈（内镜和影像学检查均显示）。3名患者复发，分别发生在蝶骨外侧壁、翼管和颞下窝各1例。进行了翻修手术，但1名患者再次复发（蝶骨外侧壁伴海绵窦浸润），并被转诊接受伽玛刀手术。
这种内镜双术者技术是治疗累及翼腭窝和颞下窝的血管纤维瘤的一种极佳方法。我们的改良通过避免鼻中隔切开和唇下切口，并通过更好地控制止血（通过上颌动脉控制），显著降低了发病率。通过仔细检查蝶骨外侧壁、翼管和颞下窝翼状肌，可将复发风险降至最低。
