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目的 :提出一种经髁突及盘后附着进路,归纳该术式的适应证、手术要点和评价临床效果。方法 :2006—2014年对5例位于颞下颌关节(TMJ)旁肿物采用上述进路。5例肿物符合以下条件—累及髁突后内侧颞下间隙较大的包膜完整的非恶性肿物,计算机模拟手术示单纯髁突离断旋转或后移无法充分暴露肿物。结果:5例肿物均得以彻底切除,未损伤重要神经,未输血。5例病例平均随访30个月,未见复发迹象。术后无继发牙颌面畸形,神经功能正常。随访时开口度平均为34 mm,均较术前有所增加(术前开口度平均为27 mm),CT示髁突固定良好,无吸收。结论:经髁突和盘后附着进路适于切除累及髁突后内侧较大的非恶性肿物,计算机设计和模拟手术有助于选择进路和适应证。
OBJECTIVE: To present an indication of the procedure, the main points of surgery and the evaluation of the clinical results through a condyle and posterior attachment approach. METHODS: From 2006 to 2014, 5 patients with TMJ were treated with the above approach. Five masses of the tumor met the following conditions - involving the intact, non-malignant mass of the posterior medial infratemporal space of the condyle, and the computer simulation of the surgery showed that the condyle alone could not fully expose the tumor. Results: All the 5 cases were completely resected, no important nerve was damaged, and no blood transfusion. Five cases were followed up for an average of 30 months, no signs of recurrence. No secondary dentition and maxillofacial deformity, normal nerve function. The mean opening degree at follow-up was 34 mm, both of which increased compared with that before operation (the average preoperative opening was 27 mm). The condyle was well fixed and showed no absorption. CONCLUSION: The condylar and posterior approach is suitable for the resection of non-malignant mass involving the medial large posterior condyle. Computer design and simulation are helpful for the selection of approach and indications.