Clinical analysis of multi-disciplinary team management in the treatment of giant neurofibroma in maxillofacial and neck region

doi:10.12016/j.issn.2096-1456.2021.12.008

Abstract

Abstract:

Objective To investigate the multi-disciplinary team (MDT) management in the treatment of giant neurofibroma in maxillofacial and neck region, to provide reference for clinical practice. Methods Retrospective analysis was conducted on the perioperative whole-process management process of 2 cases of giant neurofibroma in maxillofacial and neck region jointly formulated treatment plan by oral and maxillofacial surgery department with the assistance of the department of anesthesiology, ICU, vascular surgery, thoracic surgery, etc. Results MDT treatment process (anesthesia-embolization-collaborative surgery-ICU-post-operative management) of the two patients was smoothly conducted according to the pre-operative plan. There were no adverse events or accidents that were not predicted by the risk assessment from multiple teams during the operation, and no serious complications occurred after the operation. The post-operative pathological report of both cases was "neurofibroma". Wounds in both patients healed in stage I. The course of treatment was smooth, and the surgical treatment was completed without serious complications. Conclusion MDT management can play a positive role in the diagnosis and treatment of giant maxillofacial and neck neurofibroma so that patients can obtain safer and more effective diagnosis and treatment.

Key words: maxillofacial and neck region, neurofibroma, multi-disciplinary team, anesthesia, arterial monitoring, venous monitoring, digital subtraction angiography

摘要：

目的探讨颌面颈部巨大神经纤维瘤的多学科诊疗模式,为临床提供参考。方法由口腔颌面外科主诊,麻醉科、ICU、血管外科、胸外科等多学科参与、共同制定治疗方案的2例颌面颈部巨大神经纤维瘤患者实施围术期全程管理的流程进行回顾性分析。结果 2例患者的多学科治疗过程(麻醉-栓塞-协同手术-ICU复苏-术后管理)均按术前计划顺利实施,术中未出现多学科风险评估未预测到的不良事件或意外,均完成手术治疗,且未发生严重并发症。2例术后病理报告均为神经纤维瘤,患者伤口均I期愈合。结论多学科诊疗模式可在颌面颈部巨大神经纤维瘤的诊治中发挥积极作用,患者可以得到安全、有效的诊治。

关键词: 面颈部, 神经纤维瘤, 多学科诊疗模式, 麻醉, 动脉监测, 静脉监测, 数字减影血管造影

CLC Number:

LIU Yue,ZHANG Yi,ZHANG Jianguo,ZHANG Long,YAO Lan. Clinical analysis of multi-disciplinary team management in the treatment of giant neurofibroma in maxillofacial and neck region[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2021, 29(12): 848-853.

刘玥,张益,张建国,张龙,姚兰. 多学科诊疗模式治疗颌面颈部巨大神经纤维瘤的临床分析[J]. 口腔疾病防治, 2021, 29(12): 848-853.

Figures/Tables 6

Figure 1 Giant neurofibroma in maxillofacial and neck region (case 1) a: left neck mass; b: preoperative CT showed that the tumor size was approximately 13 cm ×11 cm × 17 cm, the upper boundary was near the skull base, the lower boundary extended to the chest through the left supraclavicular fossa, and the inner boundary was near the cervical spine; c: preoperative digital subtraction angiography showed abundant blood circulation in the tumor with bulb-holding sign

Figure 2 Giant neurofibroma in maxillofacial and neck region (case 2) a: facial appearance of the left neck mass; b: preoperative CT showed that the tumor was approximately 8 cm × 7 cm × 11 cm in size, with cystic solid interior, low-density liquefaction zone, which extended medially to the parapharynx, tracheal compression and right-side displacement, and the common carotid artery was surrounded; c: preoperative digital subtraction angiography showed abundant blood circulation in the tumor with a bulb-holding sign

Figure 3 Preoperative angiography and post-embolization images of patient with giant neurofibroma in maxillofacial and neck region (case 1) a: angiography showed that the tumor had abundant blood circulation and was spherical in shape; b: after the supplying artery was selected and embolized with gelatin sponge particles and spring coil, angiography showed that the blood flow stagnated

Figure 4 Surgical situation of patient with giant neurofibroma in maxillofacial and neck region (case 1) a: intraoperative field was clear and the tumor tissue was removed; b: the tumor was solid

Figure 5 Surgical situation of patient with giant neurofibroma in maxillofacial and neck region (case 2) a: the tumor eroded the cervical sheath (as the arrow indicated), and the tumor was removed in sections; b: a small amount of tumor tissue remained on the wall of common carotid artery and internal carotid artery and skull base

Figure 6 Images of patients with giant neurofibroma in maxillofacial and neck region 2 weeks after surgery (case 1 & case 2) a: case 1; b: case 2; the wounds of 2 patients were all healed at first stage

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