Compton Rebecca A, Scott Andrew R
Tufts Medical Center, Department of Otolaryngology-Head and Neck Surgery, Boston, MA, USA.
Tufts Medical Center, Department of Otolaryngology-Head and Neck Surgery, Boston, MA, USA; Department of Pediatric Otolaryngology-Head and Neck Surgery and Pediatric Facial Plastic Surgery, Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA.
Int J Pediatr Otorhinolaryngol. 2019 Oct;125:182-186. doi: 10.1016/j.ijporl.2019.07.005. Epub 2019 Jul 10.
To present cases of pediatric periparotid nontuberculous mycobacterial lymphadenitis excised through a facelift incision in order to review the advantages of this approach to parotidectomy. We also aim to discuss scenarios in which to forgo the facelift incision in favor of a traditional modified Blair incision.
Retrospective series of seven consecutive patients who underwent parotidectomy for nontuberculous mycobacterial lymphadenitis between 2013 and 2018.
The series included three uses of the facelift incision and four uses of the modified Blair incision, which was specifically selected for cases of bulky lymphadenopathy anterior to the masseter muscle. All cases of Modified Blair incision involved circumferential dissection of the marginal mandibular branch of the facial nerve. The facelift incision permitted complete removal of disease in cases located posterior to the masseter as well as neck dissection as inferiorly as level III. Post-operatively, temporary marginal mandibular nerve weakness was seen in all cases of Modified Blair incision. Scar widening was most notable in patients who required skin excision or dermal curettage.
The facelift incision offers a more hidden scar. This may serve as an alternative approach to parotid surgery in young children with nontuberculous mycobacterial lymphadenitis, except in cases of bulky disease anterior to the masseter muscle for which optimal exposure of the marginal mandibular nerve via a modified Blair incision is warranted.
介绍通过面部提升切口切除小儿腮腺周围非结核分枝杆菌性淋巴结炎的病例，以回顾这种腮腺切除术方法的优点。我们还旨在讨论在哪些情况下应放弃面部提升切口而采用传统的改良布莱尔切口。
回顾性分析2013年至2018年间连续7例因非结核分枝杆菌性淋巴结炎接受腮腺切除术的患者。
该系列包括3例使用面部提升切口和4例使用改良布莱尔切口，改良布莱尔切口是专门为咬肌前方肿大淋巴结的病例选择的。所有改良布莱尔切口病例均涉及面神经下颌缘支的环形解剖。面部提升切口允许完全切除咬肌后方的病变以及向下至III级的颈部清扫。术后，所有改良布莱尔切口病例均出现暂时性下颌缘神经麻痹。在需要皮肤切除或皮肤刮除的患者中，瘢痕增宽最为明显。
面部提升切口瘢痕更隐蔽。对于患有非结核分枝杆菌性淋巴结炎的幼儿，这可能是腮腺手术的另一种方法，但咬肌前方有肿大病变的情况除外，对于这种情况，通过改良布莱尔切口可确保下颌缘神经的最佳暴露。
