- 期刊
Is It Really an Atheroma? A Rare Presentation of Maxillary Apical Abscess on the Upper Nasolabial Fold Region
一個以法令紋上方之感染性皮膚腫瘤為臨床表徵的上顎齒尖膿瘍－病例報告
摘要
齒尖膿瘍為由於蛀牙侵入齒髓而造成的在齒根末端的膿瘍。這種感染可能會擴散到附近的組織而形成局部膿瘍、顏面部份的蜂窩性組織炎、下巴的皮膚瘻管、下顎的化膿性骨髓炎，頸部感染，或是縱隔腔炎。下顎齒是較常發生的部位。 這裡報告一位以發生在法令紋上方的顏面腫瘤為臨床表徵的病例。一位七十二歲的女士因第二次腫瘤再發而至本院求診，之前在他院已切除過兩次。本次切除後，傷口仍癒合不良，而且出現皮膚瘻管併持續性膿瘍流出，經換藥二週後亦無起色。之後檢查病人口腔，才發現其右上顎犬齒已蛀蝕，X光影像學檢查呈現齒根處透光線(periapical radiolucency)的現象。經轉診至牙科，並將壞牙拔除及清創後，其皮膚傷口很快就自動癒合了。 以法令紋處皮膚腫瘤為表徵的上顎齒尖膿瘍為一少見的臨床報告。當病人的顏面腫瘤切除後留下難以癒合的傷口，或是持續流膿的皮膚瘻管時，需提醒自己可能是來自牙齒的問題。
關鍵字
無資料並列摘要
An apical abscess is a dental abscess that occurs at the end of a root, caused by tooth decay which invades the pulp chamber of the tooth. This infection may spread to the adjacent area with clinical presentation of local abscess, facial cellulitis, suppurative osteomyelitis of the jaws, neck infection, or mediastinitis. They are mostly resulted from the mandibular teeth. We reported a rare case of maxillary apical abscess with the clinical presentation of an atheroma-like recurrent facial tumor over upper nasolabial fold region. A 72-year-old lady diagnosed of a recurrent facial atheroma after surgery twice was referred to us. The third time of tumor excision was performed with the result of poor wound healing. A continuous cutaneous draining sinus developed without any improvement. The pathological examination revealed granulomatous tissue with abscess formation. Tracing to the history, she didn't have any dental discomfort recently but a decayed right maxillary canine was noted in the physical examination. The radiography showed periapical radiolucency around the root. An apical abscess was impressed. After extraction of the tooth, the drainage sinus healed spontaneously. A maxillary apical abscess with the clinical presentation of an atheromalike facial tumor on upper nasolabial area was rare. It may be misdiagnosed and treated inappropriately. The surgeons should keep alert the possibility of a dental origin when facing to a chronic, unhealing facial wound after tumor excision.