Skull base surgery through the palatal approach

Treating diseases: teratoma Indication The skull base surgery for the sacral path is applicable to: 1. Tumor 1 nasopharynx angiofibroma, teratoma, dermoid cyst, etc.; 2 sphenoid sinus tumor; 3 chordoma; 4 invasion of the sphenoid sinus and pituitary pituitary tumor, combined with intracranial and extracranial resection of the tumor, Twist the incision. 2. Congenital malformation 1 after nostril atresia; 2 nasopharyngeal stenosis; 3 first and second cervical deformity. 3. Infectious lesions 1 sphenoid sinusitis; 2 sphenoid sinus cysts; 3 fungal infections, especially nasal mucormycosis and aspergillosis invading the sphenoid sinus and its surrounding tissues. Contraindications 1. A site or lesion other than the disease listed above. 2. Although the tumor belongs to the scope of the above indications, if the tumor is too large or extensively invades the malignant tumor of the adjacent tissue, it is difficult to complete the radical resection of the tumor by simply using the sputum route. Preoperative preparation 1. Take a CT film to understand the exact location and extent of the tumor or lesion in order to design the ankle incision. 2. Clean teeth and oral cleansing 1 to 2 days before surgery. 3. Start with nitrofurazone solution or antibiotic solution for 1 to 2 days before surgery. 4. Shaving the beard, shaving and cutting the nose hair 1d before surgery. 5. Prefabricated slabs for the purpose of wearing the sputum, protecting the ankle incision and fitting the iliac crest to the bone surface for healing. Surgical procedure Opener Using an opener with a tongue depressor, the tongue can be pressed forward and downward at the same time, allowing the operator to see the ankle and pharynx as much as possible. 2. Incision A U-shaped incision is made along the medial side of the temporal gingival margin. Care should be taken to include the aorta in the iliac crest without damage. 3. Peeling the flap Use the periosteal separator to peel the posterior iliac mucosal flap back along the bone surface until the trailing edge of the hard palate. 4. Deboning Use a rongeur to bite the bone plate at the back of the hard palate as needed. At the same time, you can also bite the back part of the nasal septum. The anterior boundary of the bone removal cannot reach the plane of the soft tissue incision of the ankle. Otherwise, a nose and mouth may be formed after the operation. The posterior boundary of the bone removal can reach the back of the large hole so that the flap can be flipped back as far as possible to increase the exposure. If necessary, sacrifice the aorta on one side to reveal it more backwards. 5. Remove the tumor or lesion. 6. flap reduction, suture Fill the nasopharyngeal cavity with oil gauze before the end of the operation. The flap was repositioned and the suture was interrupted. 7. Protect the hard palate cut with iodoform gauze. complication 1. Department of fistula. 2. Bleeding. 3. Infection. 4. Cerebrospinal fluid leakage.

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