经口内横断冠状突取出颞下窝与翼腭窝异物的临床回顾性分析  

Clinical study of the removal of infratemporal fossa and pterygopalatine fossa foreign bodies using a trans-oral approach

作　　者：刘军平 易晨 王建广[2] LIU Junping;YI Chen;WANG Jianguang(Department of Stomatology,Liao Bu Hospital of Guangdong Medical University,Dongguan 523400,China;Department of Oral&Maxillofacial Surgery,Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]广东医科大学寮步医院口腔科,广东东莞523400 [2]中山大学孙逸仙纪念医院口腔颌面外科,广东广州510120

出　　处：《口腔疾病防治》2018年第4期231-235,共5页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金项目(30872891)

摘　　要：目的总结颞下窝、翼腭窝异物经口内横断冠状突取出术的临床经验。方法回顾性分析2008年3月—2017年6月共收治9例颞下窝、翼腭窝异物的临床资料,其中,机械飞击伤4例,坠落伤2例,交通车祸伤2例,医源性注射器断针1例;异物种类:树枝3例,铁屑3例,碎玻璃2例,注射器断针头1例。术前均行螺旋CT三维重建及CT血管造影(CT Angiography,CTA)明确定位异物与颈内外动脉及其分支结构的关系后,全麻下行颞下窝、翼腭窝异物经口内横断冠状突径路取出术,术后1周行张口训练,随访1~6个月。结果异物独立位于翼腭窝2例、颞下窝3例,同时位于颞下窝、翼腭窝4例。9例异物均完全取出,术后1周拆线出院,术后随访1~6个月,张口度正常,咬合关系正常,无1例出现并发症。结论术前借助CT三维重建及CTA精确定位至关重要,颞下窝、翼腭窝异物,经口内横断冠状突径路取出方法可靠、有效。Objective To summarize the clinical experience of removing infratemporal fossa and pterygopalatine fossa foreign bodies via a trans-oral approach.Methods The clinical data of 9 patients with foreign bodies in the infra-temporal fossa and pterygopalatine fossa hospitalized from March 2008 to June 2017 were analyzed retrospectively.Among these cases,4 were flying injuries,2 were falling injuries,2 were traffic injuries and 1 was an iatrogenic syringe injury.Foreign bodies were divided into the following categories:3 cases of wood from branches,3 cases of iron filings,2 cases of broken glass,and one case of a broken syringe needle.Before surgery,all subjects underwent spiral CT three-dimensional reconstruction and CT angiography examinations.After accurately determining the relationship between the foreign body and the internal and external carotid arteries and their branches,patients underwent an operation under general anesthesia to remove the foreign body via a transoral approach.In addition,patients participated in mouth open-ing training for one week.Then,patients were followed for 1 to 6 months.Results Foreign bodies were removed completely in all 9 patients.Foreign bodies were independently located in the pterygopalatine fossa in 2 cases and in the in-fratemporal fossa in 3 cases.There were 4 cases of foreign bodies located in both the infratemporal fossa and the ptery-gopalatine fossa.All 9 patients had the foreign bodies completely removed and were discharged one week after surgery.They were followed for 1 to 6 months.Their mouth opening and occlusion were normal,without any complications.Con-clusion Spiral CT,3D reconstruction and CT angiography examinations are necessary and important for accurate preoperation positioning.It is feasible to remove foreign bodies in the infratemporal fossa and pterygopalatine fossa via a trans-oral approach.

关 键 词：冠状突 颞下窝 翼腭窝 异物 颌内动脉 外伤 

分 类 号：R782[医药卫生—口腔医学]