Bhardwaj Abhishek, Priya Madhu, Malhotra Manu, Varshney Saurabh, Tyagi Amit Kumar, Singh Arpana
Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 India.
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, India.
Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):1120-1127. doi: 10.1007/s12070-020-02181-5. Epub 2020 Oct 6.
Maxillary swing approaches provide excellent exposure of the anterior, mid, and anterolateral skull base offering a wide window to approach nasopharyngeal neoplasms; however, they are also associated with complications. The present study aimed to evaluate the results of a modified total maxillary swing (TMS) approach developed to minimize postoperative complications. The modified TMS approach was used to treat five patients who had extensive juvenile nasopharyngeal angiofibromas between March and October 2019 at our tertiary care center. Surgical technique, preoperative image findings, and intra-operative findings were recorded. In the postoperative follow-up, patients were examined to rule out all possible complications associated with the procedure according to the literature. A retrospective analysis was performed to assess tumor extensions, surgical modifications, and postoperative complications. All tumors had orbital and infratemporal (lateral limit) involvement while four had intracranial involvement. No per-operative complications were reported, and postoperative clinical and endoscopic evaluation was performed at 1, 2, and 3 months. There was no evidence of complications including residue, recurrence, maxillary necrosis, ophthalmoplegia, epiphora, palatal fistula, or jaw malocclusion. Besides, minor complications such as infraorbital margin skin retraction, infraorbital serous collection, maxillo-zygomatic abscess, and unsightly scar were also not seen. Only one case presented with maxillary osteomyelitis which was resolved with mini-plate removal and antibiotics. A modified TMS approach is a prudent option to ensure complete removal of juvenile nasopharyngeal angiofibromas with negligible complications.
上颌骨摆动入路能很好地暴露前、中及前外侧颅底，为鼻咽部肿瘤的切除提供了广阔视野；然而，该入路也会引发一些并发症。本研究旨在评估一种改良的全上颌骨摆动（TMS）入路的效果，该入路旨在减少术后并发症。2019年3月至10月，我们在三级医疗中心采用改良TMS入路治疗了5例患有广泛青少年鼻咽血管纤维瘤的患者。记录了手术技术、术前影像学检查结果和术中发现。术后随访时，根据文献对患者进行检查，以排除与该手术相关的所有可能并发症。进行回顾性分析以评估肿瘤范围、手术改良情况和术后并发症。所有肿瘤均累及眼眶和颞下窝（外侧界限），4例累及颅内。未报告术中并发症，术后分别于1、2和3个月进行临床和内镜评估。没有证据表明存在包括残留、复发、上颌骨坏死、眼肌麻痹、泪溢、腭瘘或颌骨错合等并发症。此外，也未观察到眶下缘皮肤回缩、眶下浆液性积液、上颌颧骨脓肿和难看瘢痕等轻微并发症。仅1例出现上颌骨骨髓炎，通过取出微型钢板并使用抗生素后得以解决。改良TMS入路是确保完全切除青少年鼻咽血管纤维瘤且并发症极少的明智选择。
