- 期刊
Rare Pharyngeal Foreign Body (Octopus Leg) in a Patient with Oral Cancer Having Trismus-Case Report
牙關緊閉口腔癌患者罕見咽部異物（章魚腳）－病例報告
摘要
Foreign body impaction in the upper aerodigestive tract is commonly observed in otorhinolaryngological practice but seldom observed in patients with head and neck cancer. Radical surgery and postoperative adjuvant therapy are the mainstay treatments for advanced oral cancer. However, these treatments can have many adverse effects, including trismus, which leads to difficulty in biting, chewing, swallowing, speaking, and even foreign body removal. A 45-year-old man with trismus and right buccal cancer pT4aN1M0 status experienced impaction of a rare foreign body (octopus leg) after radical surgery and adjuvant concurrent chemoradiotherapy. Under local anesthesia with 10% xylocaine spray and videoendoscopic guidance, the octopus leg was completely removed from the narrow oral cavity by using Fraenkel laryngeal forceps. The patient had no complications during six months of follow-up.
並列摘要
上消化道異物梗塞為一種相當常見的耳鼻喉科疾病，但在頭頸癌患者中卻相當少見。在後期之口腔癌患中，大範圍手術切除合併術後放化療或放療是目前的主要治療方式；然而，積極治療下也常常會引起許多副作用。牙關緊閉為與頭頸癌治療相關的副作用之一，其定義為咀嚼肌的強直性收縮或咀嚼間隙之纖維化，可由腫瘤生長，感染，手術或放療所引起。此會導致諸如咬合、咀嚼、吞嚥、說話甚至讓咽喉異物移除之過程變得困難。1名45歲的男性，有右側頰黏膜癌病史（病理分期為pT4aN1M0），曾在兩年前因口腔癌接受腫瘤切除手術和同步放射線及化學治療。求診時他抱怨嚴重的吞嚥疼痛，吞嚥困難和間歇性呼吸喘促1天。理學檢查發現嚴重的牙關緊閉，咽喉後壁有一個粗糙表面的黑色管狀異物。咽喉纖維內視鏡檢查顯示異物位置從左鼻咽水平延伸至右梨狀竇，並無明顯呼吸道阻塞現象。根據相關飲食病史，確認此異物為一章魚腳。在使用10%利度卡因噴霧劑局部麻醉後以及影像咽喉纖維內視鏡引導下，順利使用Fraenkel喉鉗將章魚腳經口腔狹窄的空間中移除。並在隨後6個月的門診追蹤中沒有發生相關的併發症。