Combined Transnasal and Transfacial Surgery for Maxillary Ameloblastoma-Case Report

經臉部份上頷切除術合併經鼻內視鏡手術治療上頷骨造釉細胞瘤－病例報告

呂恆安(Heng-An Lu) ； 許恆睿(Heng-Jui Hsu)

《台灣耳鼻喉頭頸外科雜誌》 57卷1期 (2022/03) Pp. 46-52

https://doi.org/10.6286/jtohns.202203_57(1).046

摘要

Ameloblastomas are rare odontogenic tumors that originate from the epithelium of the dental lamina. They occur in the maxilla and mandible at a ratio of approximately 1:4. In rare cases, a maxillary ameloblastoma that has spread to the maxillary sinus has been reported. Surgical treatment for maxillary ameloblastomas usually entails complete resection through partial or total maxillectomy. According to the 2017 World Health Organization classification, ameloblastomas can be divided into five cell subtypes: plexiform, follicular, desmoplastic, granular, and acanthomatous. This paper presents the case of a middle-aged woman who had a rare maxillary ameloblastoma with a mixed histological cell subtype and extension into the maxillary sinus. It was treated with combined transnasal endoscopic surgery and transfacial partial maxillectomy. A brief review of this rare neoplasm and the surgical steps are provided herein.

關鍵字

ameloblastoma ； maxillary tumor ； transfacial approach ； transnasal approach

並列摘要

造釉細胞瘤是一種源自於齒板上皮的罕見齒源性腫瘤，它發生在上頷骨以及下頷骨的比例約為1：4。已有少數罕見的病例報告闡述了侵蝕到上頷竇的上頷造釉細胞瘤。關於上頷造釉細胞瘤的手術治療方法，通常採用部分或全上顎骨切除術以完全移除病灶。根據2017年WHO的分類，造釉細胞瘤可分為五種細胞亞型，分別為叢狀細胞型、濾泡細胞型、結締組織增生型、顆粒細胞型以及棘皮瘤型。本篇文章闡述1名罹患罕見型態上頷造釉細胞瘤的中年女性個案，其特別之處在於罕見的混合細胞亞型以及上頷竇的侵犯。此外，在此病例中，治療的手術方法少見地選用了經臉部份上頷切除術合併經鼻內視鏡手術。本篇文章將會針對造釉細胞瘤做簡短之文獻回顧，並闡述相關手術的方法與步驟。

並列關鍵字

ameloblastoma ； maxillary tumor ； transfacial approach ； transnasal approach（造釉細胞瘤 ； 上頷骨腫瘤 ； 經臉部手術 ； 經鼻部內視鏡手術）