关键词: 解剖, 显微外科手术, 肿瘤, 硬腭, 口腭咽入路

Abstract:

Objective　To explore anatomic basis and clinical application of the transpalatal- transpharyngeal approach.　Methods　Simulated surgery via transpalatal-transpharyngeal approach was performed on 15 adult cadaveric heads injected red latex through arteries. The greater palatine foramen, incisor foramen, bone crest, palatine large artery and the soft tissue in hard palate were dissected and observed under microscope. The distances among important structures of skull base were measured and analyzed. The data of 18 cases with tumors in midline of skull base operated upon through transpalatal-transpharyngeal approach from March 2006 to July 2010 were analyzed retrospectively.　Results　The distance from the incisor foramen to the front alveolar crest was (5.18±2.44)mm.The proportion of bone crest was about 93.3%. 54 palatine large arteries coursed through the 2/3 half-width of the hard palate. The lateral limits of expose were found to be the optic nerves，carotid arteries，endostoma of hypoglossal canals and so on. Of the 18 patients, 12 were totally removed tumors, and 6 were subtotally removed tumors. The complications included rhinorrhea in 1 case and hypernasal in 1 case. There was no operative mortality and hemiplegia.　Conclusions　Transpalatal- transpharyngeal approach for resecting tumors in the midline part of skull base was an ideal approach, with satisfying exposure, alleviative operative trauma and fewer complications.

Key words: Anatomy, Microsurgical operation, Tumor, Hard palate, Transpalatal- transpharyngeal approach