Cystic degeneration of neurofibroma

Neurofibroma is also called neuroma, neuroma, peripheral fibroma, Schwann cell tumor, and peripheral fibroblast tumor. There are many names of this disease, reflecting different views on its origin, which can be summarized into the following categories: the first category: schwannoma or wangcell tumor; The second type: neurofibroma or neurofibroblastic tumor refers to the connective tissue in which tumor cells in the nerve are deepened by mesoderm leaves. Neurofibromas can originate from peripheral nerves, cranial nerves and sympathetic nerves.

Diagnosis ※

At the time of examination, it can be seen that the tumor is pink or grayish white, and the base is flat, difficult to move or pedicled, and hard. Pathological examination is needed to confirm the diagnosis.

Treatment measures ※

Not sensitive to radiation, it should be surgically removed. The surgical approach can be through the anterior nostril, the nasal side, or the extranasal ethmoidal sinus approach or Kelu operation. The midfacial exfoliation has a wide field of vision and no scar left on the face after operation, which is the best surgical method to remove neurofibroma of nasal cavity and paranasal sinuses.

Pathological changes ※

Neurilemmoma has a complete capsule, single, occasionally edema or cystic change, generally benign, rarely malignant. Most neurofibromas have no capsule and can be single or multiple. If accompanied by subcutaneous nodules and skin pigmentation, it is multiple neurofibroma, also known as Von.

Recklinghausen's disease is prone to malignant transformation. Pathologically, there are two types of tumor cells: ① The tumor cells are spiral or parallel to each other, and the cells are palisade, which is Antoni.

Type a; ② The tissue structure is loose, much like myxoma, the cells are not arranged in a certain way, and the size and shape are uneven. There is often edema fluid between tumor cells, forming tiny cysts or vesicles. This is Anthony.

Type B.

Clinical manifestations ※

There is no obvious gender difference among patients, and most of them are young and middle-aged. Growth is slow, and the course of disease can reach more than ten years. The early symptoms are mostly asymptomatic, while the later symptoms depend on the location and size of the tumor, including nasal congestion, a small amount of nosebleeds, headache and nasal or facial deformities to varying degrees. If there is Feng

Recklinghausen's disease may lead to mental retardation.

(1) Overview

Neurofibroma is a benign tumor of skin and subcutaneous tissue, which originates from nerve sheath cells and mesenchymal tissue and can occur in any part of nerve trunk and nerve endings. It can be single or multiple. But multiple tumors are the most common, and multiple tumors are neuromas.

1. The clinical manifestations of single neurofibroma are prominent on the skin surface and can be touched under the skin, which can be round, nodular or spindle-shaped. Both soft and hard, mostly soft, adults are sick and children are few. The clinical manifestations and histopathology of single neurofibroma are the same as those of multiple neurofibroma.

Neurofibroma is characterized by multiple masses, with an indefinite number, a few, and hundreds. As small as a grain of rice, as big as a fist, it can even reach more than ten kilograms. Can be loosely hung on the skin surface, wrinkles and relaxation will cause obvious deformity. When neurofibroma grows along the nerve trunk, it appears as a beaded or earthworm-like nodule (see Figure 42). In addition, the skin of neurofibroma can appear brown spots of different sizes, such as freckles, small spots or large patches, and the distribution has nothing to do with the distribution of neurofibroma masses. In a few tumor patients, coffee stain of skin pigment is one of the important diagnoses of fibroneuroma.

This disease mostly occurs in the trunk, sometimes in the limbs and face. Patients often have multiple diseases and should be distinguished.

2. Treatment If neurofibroma is located in nerve endings such as skin or subcutaneous tissue, simply remove the tumor. In particular, the laser treatment of neurofibroma without capsule, unclear boundary, vascular sinus cavity and honeycomb loose tissue in tumor tissue is superior to the traditional manual treatment. Those who cause pain, affect function and have malignant changes in appearance must be surgically removed by laser. Because of the large number of multiple neurilemmomas, those without clinical symptoms do not need to rush to surgery, which will lead to the removal of clinical symptoms.

(2) laser preoperative preparation

Various disinfection and dressing instruments can be prepared according to the size of fibroneuroma, including 65,438+0 hole towel, 2 leather forceps, 2 hemostatic forceps needles, 65,438+0 thread nails and gauze. The boundary is unclear and the operation is relatively complicated. After strict disinfection and dressing, Nd: YAG laser was used for small incision resection.

Anesthesia: local infiltration anesthesia during operation.

(3) Laser surgery

According to the shape of the tumor, the incision is selected. Tumors as small as rice grains are directly inserted into the center for cutting. Larger tumors, especially fist-shaped neurofibromas, are cut with a laser knife, and the prominent skin is made into a spindle incision. After skin incision, the assistant clamped the inner side of the incision skin with a leather clamp, and separated it along the periphery with CO2 laser (power 25W) or Nd: YAG laser tip (power 25 ~ 30w). Pay attention to whether there is obvious bleeding during operation. If there is obvious bleeding, it is more convenient to cut with Nd: YAG laser only.

Neurofibromas that grow along the nerve trunk and present as rosary or earthworm nodules should be protected during surgery. Because neurofibroma originated from nerve sheath cells and mesenchymal tissue and connective tissue supported by nerve capsule, it is not a tumor tissue directly belonging to nerve cells. After laser cutting tumor tissue, CO2 laser was used, and the power was adjusted to be lower, and the beam was parallel to the nerve trunk, and the sheath surface was cut. The actual power can be used as a test before cutting, and the output laser is normal and suitable before cutting, otherwise the nerve trunk can be easily cut off in a very short time with too high power. Be extremely careful when cutting Nd: YAG laser, because the wavelength of Nd: YAG laser is different from that of CO2 laser. CO2 laser used for single cell cutting is better than Nd: YAG laser, and Nd: YAG laser is more harmful to soft tissue than CO2 laser. Nd: YAG laser is superior to CO2 laser in removing tumors with abundant blood supply. Therefore, surgeons are required to have a comprehensive understanding of laser and be skilled in its application, and the power used is extremely important. Under the condition of fully mastering the laser, strengthening the application of anatomy can achieve the expected good results. Suture was performed according to the anatomical level after operation.

If the special tumor has no capsule, the boundary is unclear, and there are many vascular sinuses and loose honeycomb mixed tumors in the tumor tissue, the amount of bleeding is large when it is removed by routine manual operation, which can be avoided when it is removed by laser, and it is the best indication for Nd: YAG laser treatment. Surgical methods include open incision surgery and small incision closed resection. The former is strictly disinfected and diffused according to the tumor volume, injected with local 1% lidocaine infiltration, and cut the skin with Nd: YAG laser (be careful not to cut the skin with a laser knife on the face, but cut the skin with a metal scalpel first, and then peel it off with a laser knife), and cut the skin along the clear boundary of the tumor by laser. If the boundary is not clear, calculate the volume of the tumor, cut and separate it with a light knife, clean up the cavity, observe the surgically cut tissue and deal with it accordingly. Those who leave suspicious lesions must be completely removed. The postoperative pressure bandage can be used for 1 week, and no dead angle is left when the incision is sutured to avoid secondary hematoma and abscess.

Small volume mixed fibroneuroma, considering more bleeding, after local anesthesia, the optical fiber on the bare handle is directly cut into the 0.3cm hole of the skin and cut into the cavity for enclosure, and then the tissue is taken out through the hole to discharge the blood in the cavity, and the incision does not need to be sutured. After operation, the wound was wrapped with sterile gauze under pressure 1 week.

(4) postoperative treatment

After laser excision, the dressing should be changed every day without exudation, which reduces the number of dressing changes for a long time. Antibiotics 1 week and multivitamins were given after operation. If the wound pain after laser surgery is mild and the patient can tolerate it, there is no need to give analgesic drugs. The operation area is large, besides postoperative treatment, the nutrition of patients should be strengthened to make them recover as soon as possible. Bedridden patients can get fresh fruits and vegetables rich in multivitamins.