Vass Gábor, Bella Zsolt, Tóbiás Zoltán, Nagy Attila, Iván László, Rovó László
Assistant Lecturer, Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Szeged, Hungary.
Senior Lecturer, Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Szeged, Hungary.
J Oral Maxillofac Surg. 2017 Oct;75(10):2272.e1-2272.e10. doi: 10.1016/j.joms.2017.06.036. Epub 2017 Jun 29.
The widely used external approach (Weber-Fergusson incision) for the removal of maxillary ethmoid tumors leaves stigmatizing scars and deformities on the patient's face. As an alternative technique, the scarless facial degloving approach was first described in the 1970s; since then, several modifications have been developed.
The authors have been using a modified facial degloving technique for 7 years to remove maxillary ethmoid tumors. This article is a retrospective methodologic review. The inclusion criteria for this retrospective study were patients who underwent the modified facial degloving technique for management of malignant maxillary ethmoid tumors. The exclusion criteria were patients who did not undergo a surgical procedure (who received primary chemoradiation therapy) and patients who underwent an endoscopic surgical procedure for an early-stage localized tumor. The authors describe their method, which provides for a wide surgical approach using an osteoplastic flap for the entire nasal and paranasal region, with good cosmetic results. They present the adaptability of their method for 3 malignant maxillary ethmoid tumors in different locations.
From 2012 through 2016, 23 consecutive patients underwent surgery with the modified facial degloving approach at the Department of Otorhinolaryngology, Head and Neck Surgery at the University of Szeged (Szeged, Hungary). The authors evaluated their results with acoustic rhinometry and photographic documentation of postoperative facial expressions. Neither narrowing of the nasal cavity on the operated side (loss of nasal breathing function) nor facial movement dysfunction was visible in these patients.
Although several modifications of the original facial degloving approach have been published, in the present technique, the novel osteoplastic flap and the intact soft tissue of the nasal and midfacial region result in shorter hospitalization time and fewer complications. No functional or esthetic distortion was visible. No severe complications were observed; the patients' only complaint was the dryness of the nasal mucosa and temporary crusting of the nose. The present modified facial degloving technique offers proper and safe surgical resection for tumors of the maxillary ethmoid region. It can be routinely combined with endoscopic techniques and, if necessary, can be converted to an open approach.
广泛应用的用于切除上颌筛窦肿瘤的外部入路（韦伯-弗格森切口）会在患者面部留下有瘢痕的印记和畸形。作为一种替代技术，无痕面部去套入法最早在20世纪70年代被描述；从那时起，已发展出多种改良方法。
作者使用改良的面部去套入技术切除上颌筛窦肿瘤已有7年。本文是一项回顾性方法学综述。这项回顾性研究的纳入标准是接受改良面部去套入技术治疗恶性上颌筛窦肿瘤的患者。排除标准是未接受外科手术（接受原发放化疗）的患者以及因早期局限性肿瘤接受内镜手术的患者。作者描述了他们的方法，该方法使用骨成形瓣为整个鼻腔和鼻旁区域提供广泛的手术入路，具有良好的美容效果。他们展示了该方法对不同位置的3例恶性上颌筛窦肿瘤的适应性。
2012年至2016年，在匈牙利塞格德大学头颈外科耳鼻喉科，连续23例患者接受了改良面部去套入法手术。作者通过声反射鼻测量法和术后面部表情的照片记录对结果进行了评估。在这些患者中，未观察到手术侧鼻腔狭窄（鼻呼吸功能丧失）或面部运动功能障碍。
尽管已发表了对原始面部去套入法的多种改良方法，但在当前技术中，新型骨成形瓣以及鼻腔和中面部区域完整的软组织导致住院时间缩短且并发症减少。未观察到功能或美学上的变形。未观察到严重并发症；患者唯一的抱怨是鼻黏膜干燥和鼻子暂时结痂。当前改良的面部去套入技术为上颌筛窦区域的肿瘤提供了合适且安全的手术切除方法。它可以常规地与内镜技术联合使用，并且如有必要，可以转换为开放入路。
