Anehosur Venkatesh, Bindal Mohit, Kumar Niranjan, Shetty Chaitra
1SDM Craniofacial Surgery and Research Centre, SDM College of Dental Science and Hospital, Dharwad, Karnataka India.
2SDM College of Medical Science and Hospital, Dharwad, Karnataka India.
J Maxillofac Oral Surg. 2019 Sep;18(3):360-365. doi: 10.1007/s12663-018-1164-6. Epub 2018 Oct 9.
The objective of this study was to assess the accessibility in the resection of maxillary tumours, resection margin status, and morbidity following maxillectomy through lip split with paramedian mandibulotomy approach.
A retrospective review of 20 consecutive patients who underwent maxillectomy with resection of primary tumours through lip split mandibulotomy approach with supraomohyoid neck dissection for maxillary tumours between 2008 and 2016. Patients details including the tumours site, extension and neck node involvement. were recorded. Resection technique, status of surgical resected margins was also discussed. Disease status was obtained from patients follow up records. Morbidity was assessed at mandibulotomy site in terms of infection, osteotomy healing, neural disturbance and mouth opening. The institutional research committee approval was taken for this study.
All patients underwent adequate en bloc resection of the tumours, except in two patients in whom superior margins was positive. Osteotomy site healed well in our all patients except in one patient in whom there was infection at the osteotomy site during post radiation therapy. Minimal neural morbidity was encountered in four patients (three patients had lingual nerve hypothesia and two patients had inferior alveolar nerve hypothesia) which recovered in all four patients, over the 6th month post-operative period. Post-operative interincisal distance was satisfactory with a mean of 30.5 mm.
Mandibulotomy with lip split is considered to be an ideal approach to access tumours of maxilla and its adjacent structures, SOHND with level III clearance. This approach provide excellent accessibility for en bloc resection of operable maxillary tumours with good outcome of resultant scar and minimal morbidity.
本研究的目的是评估通过唇裂联合下颌骨旁正中切开术切除上颌肿瘤时的可及性、切除边缘状态以及上颌骨切除术后的发病率。
回顾性分析2008年至2016年间连续20例接受上颌骨切除术的患者，这些患者通过唇裂下颌骨切开术切除原发性肿瘤，并进行肩胛舌骨肌上颈清扫术治疗上颌肿瘤。记录患者的详细信息，包括肿瘤部位、范围及颈部淋巴结受累情况。还讨论了切除技术、手术切除边缘的状态。从患者的随访记录中获取疾病状态。在下颌骨切开部位评估发病率，包括感染、截骨愈合、神经损伤和开口情况。本研究获得了机构研究委员会的批准。
除2例患者上缘阳性外，所有患者均进行了充分的肿瘤整块切除。除1例患者在放疗后截骨部位发生感染外，所有患者的截骨部位愈合良好。4例患者出现轻微神经损伤（3例患者有舌神经感觉减退，2例患者有下牙槽神经感觉减退），所有4例患者在术后6个月内均恢复。术后切牙间距离令人满意，平均为30.5毫米。
唇裂联合下颌骨切开术被认为是一种理想的方法，可用于上颌骨及其相邻结构的肿瘤切除，并进行肩胛舌骨肌上颈清扫术（SOHND）且清扫至Ⅲ区。这种方法为可切除的上颌肿瘤整块切除提供了良好的可及性，术后瘢痕效果良好，发病率最低。
