ENT Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
Clin Otolaryngol. 2021 May;46(3):659-664. doi: 10.1111/coa.13704. Epub 2021 Jan 10.
To describe the midfacial degloving approach and compare the varying surgical approaches to juvenile angiofibromas. To demonstrate the efficacy of midfacial degloving in treating large juvenile angiofibromas in a unique patient cohort.
A retrospective case-series between 2006 and 2019.
All patient care was undertaken at a regional skull base referral centre.
Twenty-one male patients with a median age of 18 (range 16-45 years).
Presenting symptoms, imaging, stage, age at operation, residual disease, estimated blood loss and operative time were all recorded. Postoperative outcomes included complications, length of stay and recurrence.
The median surgical time was 105 minutes (range 55-219 minutes), median estimated blood loss 600 mls (range 150-900 mls) and median length of stay was 4 days (range 2-13 days.). Complications included two episodes of epistaxis, one requiring packing and one return to theatre. 14% (3/21) of patients had residual disease, none requiring further treatment and one patient had recurrence.
MFD for JNA in our series resulted in low recurrence rate and no progression of residual disease. The approach has been successful in our cohort of patients and is an option in males over the age of 16 years, with JA extending beyond the nasopharynx and sinuses, involving the infratemporal fossa, cavernous sinus or orbital region.
描述面中部脱套入路，并比较青少年血管纤维瘤的各种手术入路。展示面中部脱套入路在治疗独特患者群体中的大型青少年血管纤维瘤的疗效。
2006 年至 2019 年之间的回顾性病例系列。
所有患者的护理均在区域颅底转诊中心进行。
21 名男性患者，中位年龄 18 岁（范围 16-45 岁）。
记录主要症状、影像学表现、分期、手术年龄、残留疾病、估计失血量和手术时间。术后结果包括并发症、住院时间和复发。
中位手术时间为 105 分钟（范围 55-219 分钟），中位估计失血量为 600 毫升（范围 150-900 毫升），中位住院时间为 4 天（范围 2-13 天）。并发症包括两次鼻出血，其中一次需要填塞，一次需要返回手术室。14%（3/21）的患者有残留疾病，均无需进一步治疗，且 1 例复发。
我们的系列中，MFD 治疗 JNA 复发率低，残留疾病无进展。该方法在我们的患者群体中取得了成功，是年龄在 16 岁以上、JA 延伸至鼻咽和鼻窦以外、累及颞下窝、海绵窦或眼眶区域的男性患者的一种选择。
