- 期刊
局部下顎骨切除後鄰牙之牙髓病治療－病例報告
Endodontic Treatment of a Right Lower Lateral Incisor Proximal to a post-partial Mandibulectomy wound-case Report
摘要
中心巨細胞肉芽腫主要發生於兒童或青少年，女性多於男性，常發生在下顎。本篇報告一位十五歲的少女的案例，她三年前因右側下顎區逐漸隆起的腫塊而到他院求診，接受局部下顎骨切除手術後，以重建板(reconstruction plate)及腓骨骨皮瓣(fibular osteocutaneous flap)重建，病理報告診斷為下顎骨中心巨細胞肉芽腫。手術三年後，因牙痛及尋求贋復重建而來本院看診，發現病患因局部下顎骨切除，造成下領右側側門齒的遠心側支持齒槽骨幾乎完全喪失併牙髓壞死，引發牙齒疼痛及動搖。經髓腔開擴，根管擴大及長期氫氣化鈣糊劑置換之牙髓病治療，及暫時性贋復重建。一年半之後，透過X光片和臨床檢查，發現原本喪失之齒槽骨重新生成，動搖度也明顯降低，故再施以馬來膠針及Canals根管封塡劑做根管塡充，以保存此牙齒，待病患成年之後再施予永久性贗復重建。
並列摘要
Central giant cell granulomas commonly occur in children and young adults with a slight predilection for females. The mandible has been identified as being a more-common location for its development. We report on a 15-year-old girl. Three years ago, she went to a local hospital for help with a gradually enlarging mass over her right-side mandible. The patient underwent partial resection of the mandible and floor of the mouth tissues from the right canine to the right third molar. The mandibular defect was reconstructed with a fibular osteocutaneous flap using a reconstruction plate for rigid fixation. The pathology report was central giant cell granuloma. Three years after surgery, the patient came to our hospital because of a toothache and dental prosthetic reconstruction. The distal alveolar bone was almost obliterated, and pulp necrosis on the right side of the mandibular lateral incisor was noted due to the partial mandibulectomy. This had resulted in the toothache and mobility of the right-side mandibular lateral incisor. The patient underwent on open-chamber, canal enlargement, long-term dressing of calcium hydroxide paste of the right side mandibular lateral incisor, and temporary prosthetic reconstruction. After 1.5 years, we found that the new formation of the distal alveolar bone on the right side of the mandibular lateral incisor and its mobility had greatly decressed according to radiography and a clinical examination. Therefore, we filled the root canal with gutta-percha points and canal sealer to preserve it. The permanent prosthetic reconstruction will not be considered until the patient has grown up.
延伸閱讀
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