上顎骨全摘術に対する内視鏡的および経口的アプローチの併用

Combined Endoscopic and Transoral Approach for Total Maxillectomy.

抄録

上顎摘出術は、1820年代に初めて報告されて以来、その術式が見直されてきました。過去10年間、内視鏡的アプローチは上顎骨切除のために広く実践されてきた。従来の方法に比べ，内視鏡と経口的アプローチの併用は，顔面切開や術後瘢痕の回避，術縁の視認性など，多くの利点がある．しかし、この方法は習得が難しく、いくつかの課題を抱えている。ここでは、上顎骨全摘術の方法をステップバイステップで紹介する。また、上顎に発生した悪性腫瘍の9例を報告し、全例に内視鏡と経口的アプローチを併用した上顎全摘術を施行した。その結果、内視鏡と経口的アプローチの併用により、上顎骨全摘術は成功したが、下顎骨窩や翼口蓋窩に進展した腫瘍は、局所への転移を避けるために慎重に治療する必要があることがわかった。また、上顎骨全摘術後のQOLを向上させるために、義歯以外の再建法も試みる必要がある。

The technique of maxillectomy has been revised since it was first described in the 1820s. During the past decade, the endoscopic approach has been widely practiced for resecting maxilla. Compared with the traditional approaches, the combined endoscopic and transoral approach has many advantages such as avoiding facial incisions and postoperative scars and better visualization of the surgical margin. However, this technique is complicated to master and possess several challenges. Here, we demonstrate this approach step-by-step to show how to perform a total maxillectomy. We also reported nine cases with malignant tumors originating from the maxilla, and for all of them total maxillectomy was performed with combined endoscopic and transoral approach. Our data showed that the combination of the endoscopic and transoral approach could be used to resect the total maxilla successfully, though the tumor extended to the infratemporal and pterygopalatine fossa should be treated very carefully to avoid its spread in the local area. Furthermore, besides denture, other reconstruction methods should be attempted to improve the postoperative quality of life after the total maxillectomy.