Facial and cervical schwannoma resection

Face and neck nerve sheath tumor resection for the treatment of facial and cervical schwannomas. Schwannoma, also known as schwannomas and Schwannoma, is a neurogenic benign tumor derived from the nerve sheath. Head and neck schwannomas occur mostly in cranial nerves (such as vagus nerve, lingual nerve, hypoglossal nerve, facial nerve, accessory nerve, etc.) and spinal nerves (such as cervical plexus nerve), which are rare in sympathetic nerves. The clinical manifestations of schwannomas are circular or oval-shaped masses in the cervical, anterior triangle, pharynx, and tongue. Generally, the growth is slow, the disease is long, painless, and the texture is tough and medium-hard. The surface is smooth, has a complete envelope, and has no adhesion to the surrounding tissue. The tumor can move left and right along the nerve axis, but it is not easy to move up and down. Generally, the tumor is small, but it can grow and be lobulated. The middle part can also be mucoid and liquefied. The liquid can be extracted and it is a blood sample but does not coagulate. The tumor is located in the anterior triangle of the neck and the parapharyngeal side can shift the carotid artery. A typical Horner syndrome can occur in patients with sympathetic and tumor-compressed sympathetic nerves. From the vagus nerve and tumor compression vagus nerve, there is a irritating cough, the patient coughs when drinking water, and some also have hoarseness and other symptoms. And from the cervical plexus and brachial plexus, clinically can have tender and radioactive spontaneous pain. Treatment of diseases: schwannomas Indication All patients with clinical diagnosis of schwannomas should be surgically removed. Clinically, there are also malignant changes in this tumor. Although it is a minority, it should be taken seriously. Contraindications There are no special contraindications other than considering the patient's general condition and determining whether it can tolerate this procedure. However, if the tumor is close to the skull base and is closely related to the large blood vessels in the neck, the operation should be carried out with caution to prevent accidents. Preoperative preparation 1. Regular examination of the general condition, patients with major organs, should be treated after healing or remission. 2. Local B-ultrasound, carotid angiography, digital subtraction angiography (DSA) or magnetic resonance imaging (MRI) to understand the relationship between the tumor and the total neck, internal and external carotid arteries, clear the large blood vessels of the neck The location and depth. 3. Necessary drug allergy test. 4. Matching blood. 5. In the operation, there is the possibility that the tumor-derived nerve is damaged and sacrificed, and corresponding preparations should be made to formulate a careful treatment plan. Surgical procedure Incision The growth site of schwannomas is often not constant, and the choice of surgical incision should be selected according to the size of the tumor, the location of the tumor, the clear visibility of the surgical field, and the avoidance of damage to important nerve vessels. In general, the submandibular arc incision is often used. Sometimes, in order to expose the carotid artery, an oblique longitudinal incision is applied along the sternocleidomastoid muscle to form a T-shaped incision. If the tumor is located in the upper middle part of the neck, an oblique longitudinal incision is often used. A longitudinal incision should be taken for the sphincter of the tongue. 2. Reveal the tumor According to the incision, the incision is divided into two layers. Because the tumor capsule is intact and there is no adhesion to the surrounding tissue, the peeling is often smooth. In order to prevent important nerve damage, one should be based on blunt dissection, and the second is to stay close to the tumor and prevent it from staying away. The submandibular and upper neck tumors often protrude into the skull base area, and should not be blindly performed when peeling off. If necessary, the mandibular ascending branch should be cut off and retracted to both sides, and the tumor should be stripped under direct vision to ensure safety. After that, the jaw is fixed and fixed. 3. Intraoperative nerve processing A sheath tumor derived from the spinal nerve can not completely preserve the nerve. Those from the brain and sympathetic nerves should be carefully stripped. Intraoperative harassment and damage to these important nerves should be avoided as much as possible, especially the vagus nerve, which may cause sudden cardiac arrest due to stimulation. Other important nerve damage can also have varying degrees of adverse consequences. Therefore, it is absolutely impossible to cut off the nerve trunk that is close to or through the tumor for the purpose of removing the tumor, and the accidental injury should also be kissed immediately. During the operation, the outer membrane should be cut along the longitudinal axis of the nerve trunk on the tumor, and the nerve fiber bundle should be carefully and carefully peeled off to remove the tumor. For nerves that pass through the tumor, the tumor should be dissected, and the nerve trunk should be isolated and then the tumor removed. 4. Close the wound After the tumor is resected, the wound is washed, the ineffective cavity is eliminated, the suture is layered, the negative pressure drainage or the half tube drainage is performed. complication 1. The vagus nerve and its branches may undergo hoarseness and cough after surgery. 2. Horner syndrome can occur after sympathetic injury. 3. Sublingual nerve injury can cause atrophy of the semitonal lingual muscle after surgery. 4. Wound hemorrhage is mostly caused by cervical vascular injury and is not properly treated. A small amount of bleeding can be given to the hemostatic agent, local compression dressing; a large number of bleeding should open the wound, re-ligation and stop bleeding. 5. For patients with nerve damage, neurotrophic drugs such as vitamin B1 and vitamin B12 should be given after surgery, and it is expected to restore function in half a year or so.

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