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目的:介绍一种腮腺切除术中保留耳大神经和腮腺筋膜的改良方法。方法:取常规S形切口,在腮腺筋膜浅面先向前游离皮瓣至腮腺近前缘,再于耳垂前1cm处纵形切开腮腺筋膜,在腮腺筋膜深面、腮腺组织表面向后游离至胸锁乳突肌,形成皮肤筋膜瓣。在游离过程中,将耳大神经主干及耳垂支、耳后支保留在皮肤筋膜瓣上,最后向前游离筋膜瓣。完成腮腺切除后,将前、后腮腺筋膜瓣折叠,拉紧缝合。结果:45/46例患者获得随访。术后3例分别在5个月、9个月和11个月出现轻度Frey综合征。9例术后出现耳垂暂时麻木,1～3个月后恢复感觉。下颌后凹陷不明显,无涎瘘发生。结论:改良的手术方法能完好地保留腮腺筋膜和耳大神经耳垂支、耳后支,显著降低相应并发症的发生。
OBJECTIVE: To introduce an improved method of preserving the auricular and parotid fascia during parotidectomy. Methods: The conventional S-shaped incision was performed. The anterior flank of the parotid gland in the superficial parotid fascia surface was dissected to the anteroposterior of the parotid gland. The parotid fascia was excised longitudinally 1 cm before the lobe. In the parotid gland, the surface of the parotid gland After the free sternocleidomastoid muscle, the formation of skin fascia flap. In the process of freeing, the large auricular trunk and earlobe branch, ear posterior branch remain on the skin fascia flap, the last of the free fascia flap forward. After the completion of parotid gland resection, the anterior and posterior parotid fascia flap fold, tighten the suture. Results: 45/46 patients were followed up. Three patients had mild Frey syndrome at 5 months, 9 months and 11 months respectively. Nine cases of postoperative lobulation temporary numbness, 1 to 3 months after the recovery feeling. Mandibular depression is not obvious, no salivary fistula occurred. Conclusion: The modified operation method can well preserve the parotid fascia and large ear lobes and posterior branch of ear, and significantly reduce the corresponding complications.