London Nyall R, Chan Jimmy Y W, Carrau Ricardo L
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
Semin Plast Surg. 2020 May;34(2):99-105. doi: 10.1055/s-0040-1709432. Epub 2020 May 6.
Multiple anterior surgical approaches are available to obtain access to the nasopharynx, clivus, and craniocervical junction. These include the direct and transoral robotic surgery transpalatal, maxillary swing, and endoscopic endonasal approaches. In this article, we describe the indications for these techniques, surgical steps, and associated morbidities. This article is a PubMed literature review. A review of the literature was conducted to assess the techniques, surgical steps, and associated morbidities with transpalatal approaches to the skull base and nasopharynx. The transpalatal approach has been traditionally utilized to obtain surgical access to the nasopharynx, clivus, and craniocervical junction. Morbidity includes velopalatine insufficiency due to shortening of the soft palate from scar contraction or neuromuscular damage, thus leading to hypernasal speech and dysphagia. Middle ear effusion and oronasal or oronasopharyngeal palatal fistula are additional potential morbidities. The choice of surgical approach depends on a variety of factors including the disease location and extent, surgeon experience, and available resources.
有多种前路手术入路可用于显露鼻咽、斜坡和颅颈交界区。这些入路包括经口直接手术、经口机器人手术、经腭入路、上颌骨摆动入路和鼻内镜下鼻内入路。在本文中，我们描述了这些技术的适应证、手术步骤及相关并发症。本文是一篇PubMed文献综述。我们进行了文献回顾，以评估经腭入路至颅底和鼻咽的技术、手术步骤及相关并发症。传统上，经腭入路用于获得鼻咽、斜坡和颅颈交界区的手术显露。并发症包括由于瘢痕收缩或神经肌肉损伤导致软腭缩短引起的腭咽闭合不全，进而导致鼻音过重和吞咽困难。中耳积液以及口鼻腔或口鼻咽腭瘘是其他潜在的并发症。手术入路的选择取决于多种因素，包括疾病的位置和范围、术者经验以及可用资源。
