与张口受限相关的90毫米巨大骨化茎突舌骨链

文献信息

中文摘要

一名62岁男性因右侧下颌下疼痛六个月并随后出现吞咽困难而被转诊。就诊时最大切牙间开口度为25毫米。计算机断层扫描血管造影显示右侧骨化茎突舌骨链自颅底延伸至舌骨区。其长度为90毫米，最大横截面为17.5×10.5毫米。该链与颈外动脉接触，距颈内动脉1.1毫米，并伴有该链与寰椎横突之间颈内静脉的局限性狭窄，静脉通畅性保留。由于张口受限，气管插管需在纤维支气管镜和视频喉镜联合引导下完成。在全麻和神经肌肉阻滞下，由手术医生用直尺测量最大被动切牙间开口度，切除前仍为25毫米，使用金刚石钻头经颈切除后立即增至45毫米。远端该链通过残留的茎突舌骨韧带附着于舌骨小角，该韧带被松解而未行舌骨截骨。两段切除碎片合计长度为80毫米，约10毫米的近端节段被有意保留。疼痛缓解，六个月时最大切牙间开口度为42毫米。本病例强调了血管成像的价值、茎突舌骨测量的精确界定，以及在不明原因张口受限中考虑Eagle综合征。

英文摘要

A 62-year-old man was referred with a six-month history of right submandibular pain followed by dysphagia. At presentation, maximal interincisal opening was 25 mm. Computed tomography angiography demonstrated an ossified right stylohyoid chain extending from the skull base to the hyoid region. It measured 90 mm in length and 17.5 × 10.5 mm at maximal cross-section. The chain contacted the external carotid artery, lay 1.1 mm from the internal carotid artery, and was associated with focal narrowing of the internal jugular vein between the chain and the transverse process of the atlas, with preserved venous patency. Because of restricted mouth opening, tracheal intubation required combined fiberoptic and videolaryngoscopic guidance. Under general anesthesia and neuromuscular blockade, maximal passive interincisal opening, measured with a ruler by the operating surgeon, remained 25 mm before resection and increased immediately to 45 mm after transcervical resection using a diamond burr. Distally, the chain was attached to the lesser horn of the hyoid bone by a residual stylohyoid ligament, which was released without hyoid bone osteotomy. The two excised fragments measured 80 mm in combined length, with an approximately 10-mm proximal segment intentionally retained. Pain was resolved, and maximal interincisal opening was 42 mm at six months. This case highlights the value of vascular imaging, precise definition of stylohyoid measurements, and consideration of Eagle syndrome in unexplained restriction of mouth opening.