多形性腺瘤浅表性腮腺部分切除术的顺行入路与逆行入路手术效果比较：颧支引导逆行入路手术新技术

IF 1.6 4区医学 Q2 OTORHINOLARYNGOLOGY

Auris Nasus Larynx Pub Date : 2025-04-21 DOI:10.1016/j.anl.2025.04.004

Akihito Tarui , Ryusuke Hori , Tsuyoshi Kojima , Yusuke Okanoue , Atsushi Taguchi , Shuya Otsuki , Hideaki Okuyama , Harukazu Hiraumi

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引用次数: 0

摘要

目的腮腺多形性腺瘤常行腮腺浅表性部分切除术。Blair切口常用于腮腺浅表性切除术，可提供广泛的手术暴露，但会留下明显的耳周疤痕，与面部皮肤乳沟线错位。为了提高美观性和减少侵入性，我们根据肿瘤的位置，采用耳后切口的顺行入路（AA）或耳前切口的颧分支（ZB）或弧形颈部切口的下颌边缘分支（MB）引导的逆行入路（RA）。值得注意的是，由ZB引导耳前切口的RA是一种新颖的技术。本研究提出了一种新的RA技术，并定义了AA和RA的适应症。方法肿瘤部位不同，入路不同。如果肿瘤位于腮腺尾部或前缘，我们分别选择由边缘MB引导的RA，采用弧形颈部切口，或由ZB引导的RA，采用鬓角内耳前切口。对于其他病例，无论肿瘤大小，均选择耳后切口AA。结果241例患者中，AA 195例，RA 46例；MB引导RA 20例，zb引导RA 26例。AA和RA的平均手术时间分别为94.6和64.0 min。MB和zb引导RA的平均手术时间分别为77.1 min和53.8 min。RA组手术时间明显短于AA组；zb引导RA组手术时间最短。AA和RA的平均出血量分别为43.8和11.4 mL。MB引导RA平均出血量17.6 mL， zb引导RA平均出血量6.8 mL。RA组出血量明显少于AA组；三组中zb引导RA出血量最少。并发症发生率低，术后沿耳后和颈部乳沟线或鬓角的切口疤痕在美容上令人满意。结论在本研究中，我们报道了一种新的由ZB引导的RA手术技术。手术结果和术后美学效果良好，支持我们的手术指征对AA和RA的适用性，以及ZB引导下耳前切口RA的实用性。

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Comparison of surgical outcomes between anterograde and retrograde approaches for partial superficial parotidectomy in pleomorphic adenoma: A new surgical technique of the retrograde approach guided by the zygomatic branch

Objective

Partial superficial parotidectomy is commonly performed for pleomorphic adenoma of the parotid gland. The Blair incision, frequently used for superficial parotidectomy, provides wide surgical exposure but leaves a visible periauricular scar misaligned with facial skin cleavage lines. To enhance esthetics and reduce invasiveness, we use the anterograde approach (AA) with a postauricular incision or the retrograde approach (RA) guided by either the zygomatic branch (ZB) with preauricular incisions or the marginal mandibular branch (MB) with an arc-shaped neck incision, depending on tumor location. Notably, the RA guided by the ZB with preauricular incision is a novel technique. This study presents a new RA technique and defines indications for AA and RA.

Methods

The approach varied depending on tumor location. If the tumor was located in the tail or anterior border of the parotid gland, we selected the RA guided by the marginal MB using an arc-shaped neck incision or the RA guided by the ZB using a preauricular incision within the sideburns, respectively. For other cases, AA using a postauricular incision was selected regardless of the tumor size.

Results

Among 241 patients, AA was performed in 195 and RA in 46 patients; MB- and ZB-guided RA were performed in 20 and 26 patients, respectively. The mean operation times for AA and RA were 94.6 and 64.0 min, respectively. The mean operation times for MB- and ZB-guided RA were 77.1 and 53.8 min, respectively. The operation time was significantly shorter in RA than in AA; ZB-guided RA had the shortest operation time in the three groups. The mean bleeding volumes were 43.8 and 11.4 mL in AA and RA cases, respectively. The mean bleeding volumes of MB- and ZB-guided RA were 17.6 and 6.8 mL, respectively. The bleeding volume was significantly less in RA than in AA; ZB-guided RA had the least bleeding volume in the three groups. Complication rates were low, and postoperative incision scars along the postauricular and neck cleavage lines or on sideburns were cosmetically satisfactory.

Conclusion

In the present study, we reported a novel surgical technique for RA guided by the ZB. The surgical results and postoperative aesthetic outcomes were favorable, supporting the appropriateness of our surgical indications for AA and RA and the utility of RA guided by ZB with a preauricular incision.

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来源期刊

Auris Nasus Larynx 医学-耳鼻喉科学

CiteScore

3.40

自引率

5.90%

发文量

169

审稿时长

30 days

期刊介绍： The international journal Auris Nasus Larynx provides the opportunity for rapid, carefully reviewed publications concerning the fundamental and clinical aspects of otorhinolaryngology and related fields. This includes otology, neurotology, bronchoesophagology, laryngology, rhinology, allergology, head and neck medicine and oncologic surgery, maxillofacial and plastic surgery, audiology, speech science. Original papers, short communications and original case reports can be submitted. Reviews on recent developments are invited regularly and Letters to the Editor commenting on papers or any aspect of Auris Nasus Larynx are welcomed. Founded in 1973 and previously published by the Society for Promotion of International Otorhinolaryngology, the journal is now the official English-language journal of the Oto-Rhino-Laryngological Society of Japan, Inc. The aim of its new international Editorial Board is to make Auris Nasus Larynx an international forum for high quality research and clinical sciences.