Tsunoda Atsunobu, Kishimoto Seiji, Tou Miri, Anzai Takashi, Matsumoto Fumihiko, Oba Shinichi, Ikeda Katsuhisa
Department of Otolaryngology, Juntendo University Nerima Hospital, Tokyo, Japan.
Department of Otolaryngology, Kameda Medical Center, Kamogawa, Japan.
Ear Nose Throat J. 2021 Dec;100(10_suppl):1041S-1044S. doi: 10.1177/0145561320935834. Epub 2020 Jun 18.
We introduce here our surgical approach for the removal of a huge parapharyngeal tumor in 3 cases. Surgery was done under general anesthesia using transnasal intubation. Transoral manipulation was performed first. Using a tongue retractor and an angle widener, a wide surgical field was provided. Incision was made on the palate around the tumor. Tumor was separated from the surrounding tissue, preserving the tumor capsule. Then, a 5-cm small skin incision was made. Both parotid and submandibular glands were pushed upward, and the parapharyngeal space was opened. The tumor was also separated from the surrounding tissue. These manipulations were done under endoscopic observation. Finally, the tumor was pushed laterally and safely removed intraorally. After removal of the tumor, the wounds were closed, and vacuum drainage was settled for a few days. No apparent problems, such as malocclusion and facial palsy, occurred, and the patients were free from disease for more than 10 years. For the removal of a large parapharyngeal tumor, the mandibular swing approach is usually used; however, this approach is invasive, and certain sequelae, such as facial wound and malocclusion, may occur. Our technique enables the safe and less invasive removal of such a huge parapharyngeal benign lesion.
在此，我们介绍3例巨大咽旁肿瘤切除术的手术方法。手术在全身麻醉下经鼻插管进行。首先进行经口操作。使用舌牵开器和角度扩大器，提供广阔的手术视野。在肿瘤周围的腭部做切口。将肿瘤与周围组织分离，保留肿瘤包膜。然后，做一个5厘米的小皮肤切口。将腮腺和下颌下腺向上推，打开咽旁间隙。同样在肿瘤周围组织分离肿瘤。这些操作在内镜观察下进行。最后，将肿瘤向外侧推，经口安全切除。肿瘤切除后，关闭伤口，并放置负压引流管数天。未出现明显问题，如咬合不正和面神经麻痹，患者无病生存超过10年。对于巨大咽旁肿瘤的切除，通常采用下颌骨摆动入路；然而，该入路具有侵袭性，可能会出现某些后遗症，如面部伤口和咬合不正。我们的技术能够安全、微创地切除如此巨大的咽旁良性病变。
