Mathur Neeraj Narayan, Vashishth Ashish
Department of ENT and Head and Neck Surgery, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India,
Eur Arch Otorhinolaryngol. 2014 Nov;271(11):3035-40. doi: 10.1007/s00405-013-2804-6. Epub 2014 Jan 4.
The objective of this study was to evaluate the efficacy and outcome using the maxillary swing approach for the management of extensive nasopharyngeal angiofibromas. A retrospective analysis in a tertiary care center revealed five cases with extensive nasal angiofibromas operated using the maxillary swing approach between 2010 and 2012. All patients had tumor extension to the lateral-most portions of the infratemporal fossa with complete occupation and destruction of the lateral wall of the sphenoid sinus causing abutment to the cavernous sinus and complete involvement of the pterygopalatine fossa and pterygoid base. One patient displayed full occupancy of the maxillary sinus as a consequence of erosion of the posterior and medial walls of the maxillary sinus, while another had severe temporal lobe compression through the roof of the infratemporal fossa. All patients underwent tumor excision using the maxillary swing approach. Patients were followed up for a minimum period of 1 year after surgery. The maxillary swing approach gave optimal exposure of the entire central skull base including the infratemporal fossa and its extreme lateral and superior aspects. Adequate tumor exposure and vascular control could be achieved in all cases resulting in complete tumor excision. The mean operative time was 4.5 h. Post-operative healing was satisfactory with palatal fistula formation in two cases and all patients remaining disease-free up to the present time. One had minimal misalignment of the halves of the upper jaw and two had epiphora, of which one required dacryocystorhinostomy. The maxillary swing is an effective approach in the management of extensive nasopharyngeal angiofibromas and leads to optimal anatomical exposure with minimal morbidity.
本研究的目的是评估采用上颌骨摆动入路治疗广泛型鼻咽血管纤维瘤的疗效和结果。在一家三级医疗中心进行的回顾性分析显示，2010年至2012年间有5例广泛型鼻腔血管纤维瘤患者采用上颌骨摆动入路进行了手术。所有患者的肿瘤均延伸至颞下窝最外侧部分，蝶窦外侧壁完全被占据并破坏，导致与海绵窦相邻，翼腭窝和翼突基部完全受累。1例患者因上颌窦后壁和内侧壁侵蚀导致上颌窦完全被占据，另1例患者因颞下窝顶部压迫导致严重颞叶受压。所有患者均采用上颌骨摆动入路进行肿瘤切除。术后对患者进行了至少1年的随访。上颌骨摆动入路能最佳暴露整个中颅底，包括颞下窝及其最外侧和最上方区域。所有病例均能实现充分的肿瘤暴露和血管控制，从而完整切除肿瘤。平均手术时间为4.5小时。术后愈合情况良好，2例出现腭瘘，所有患者至今均无疾病复发。1例患者上颌两半轻度错位，2例患者出现溢泪，其中1例需要行泪囊鼻腔吻合术。上颌骨摆动入路是治疗广泛型鼻咽血管纤维瘤的有效方法，能实现最佳的解剖暴露，且并发症最少。
