腮腺良性肿瘤手术的美容设计(1)
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[摘要]目的：探讨如何通过改良术式达到腮腺良性肿瘤手术的美学效果。方法：改良术式手术治疗腮腺良性肿瘤75例。术式中对以下方面作了相应改良：切口设计、耳大神经的保护、腮腺区域性切除、胸锁乳突肌瓣的应用、腮腺残端的处理等。随访观察该切口的美观程度以及临床疗效。结果：所有患者均达临床一期愈合，无涎瘘发生。13例患者术后出现暂时面瘫，3个月后恢复。所有患者术后均出现不同程度的耳垂麻木，于术后2个月恢复。患者对该切口的美观程度比较满意。结论：改良的腮腺肿瘤术式提高了手术的整体质量，克服了部分经典腮腺手术带来的美观方面的缺陷。
[关键词]腮腺良性肿瘤；改良术式；美容
[中图分类号]R782 [文献标识码]A [文章编号]1008-6455(2011)10-1546-03
Aesthetics design ofthe operation of the partotid benign tumor
WANG Wen-feng,ZHEN Dong-xin,REN Chang-qun,ZHOU Jian-hong
(Department of Oral and Maxillofacial Surgery,PLA 180th Hospital,Quanzhou 362000,Fujian,China)
Abstract:ObjectiveTo discuss how to obtain the aesthetics destination of a modified operation technique in the treatment of parotid benign tumor.Methods75 clinic cases were chosen to use the modified operation technique.The operation had been improved in following aspects:incision position,preserving major auricular nerve,partial parotid excision,the application of sternocleidomastoid flaps,the management of parotid stump.The follow up study included the cosmetic effect of this incision and the clinical outcome.ResultsThe modified incisions healed uneventfully in all patients without salivary fistulae.13 patients undergo facial nerve paralysis but recovered 3 months after surgery.All the patients felt earlobe insensible after operation,but recovered 2 months later All the patients were relatively satisfied with the facial features and functions.Conclusion The improvement of operation for parotid tumors enhances the whole quality of surgical treatment,without leaving the partial cosmetic defects resulted from the classical operation technique.
Key words:benign parotid tumours;modified approach;aesthetics
本文旨在通过腮腺良性肿瘤外科手术过程中各个方面细节的讨论，包括设计手术切口、保护耳大神经、预防Frey综合征等方面，来共同讨论如何达到腮腺良性肿瘤外科手术后的美容效果。
1资料和方法
1.1 临床资料：2005～2010年收治的患者中，术中病理冰冻检验为良性病变并接受改良术式的腮腺浅叶良性肿瘤75例(男55例，女20例)，年龄11～92岁。术后病理证实，多形性腺瘤45例，腺淋巴瘤 24例，结核3例，castleman结节1例，神经鞘瘤1例，表皮样囊肿1例。
1.2 手术方法
1.2.1 手术切口的设计：由传统的腮腺“S”形切口改良而来，按肿瘤所在区域选择手术切口与进路。位于耳前区或耳垂下的肿瘤选择类V形切口：切口起点为耳屏前上方处，可向上延伸至鬓角发迹，沿耳屏游离缘向下经由耳垂前皱纹绕过耳垂至耳垂后沟。位于下颌角区、颌后区的肿瘤选择类N形切口：皮肤切口从耳屏缘前绕过耳垂，延伸至耳后乳突区，再向前转向颌下切口。总长度6.2～10.0cm，平均8.5cm。
1.2.2耳大神经的妥善处理：分离后方皮瓣时，在切口下缘胸锁乳突肌表面寻找耳大神经。由于切口小，只能暴露胸锁乳突肌的上端，此时神经已经由深变浅。在翻后方皮瓣时不宜过深 ......
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