後臼齒三角區鱗狀細胞癌之外科治療考慮－回溯性研究

Surgical Consideration in Squamous Cell Carcinoma of Retromolar Trigone-Retrospective Study

顏欽堉(Chi-Yui Yen) ； 劉巡宇(Shyun-Yen Liu)

《中華民國口腔顎面外科學會雜誌》 10卷2期 (1999/09) Pp. 93-100

https://doi.org/10.7104/CJOMS.199909.0093

摘要

後臼齒三角區為一由最後臼齒之遠心面開始，向上至上顎粗隆，外側連接頰黏膜，內側則延伸至前扁桃腺柱之區域。此區域之構造複雜，上皮有黏膜及牙齦，上皮下軟組織層薄且緊貼著骨骼，周圍有豐富之肌肉及血液淋巴系統。因此後臼齒三角區之鱗狀細胞癌容易侵犯下顎骨、翼肌及嚼肌，亦容易頸部林巴轉移。此外其位置接近口咽部且受下顎骨外斜線(external oblique line)、下顎枝、上顎粗隆等解剖構造的阻礙，欲手術切除此區域之病灶相當困難。進行手術切除此區域之鱗狀細胞癌時須統此區域之特殊性質加以考慮。本文以奇美醫院自1991年至1997年間21位接受過手術治療之後臼齒三角區患者進行回溯性研究，探討治療後臼齒三角區鱗狀細胞癌可能影響手術結果之因素，各種切除腫瘤的術式與術後重建的選擇。結果發現除了應採取較大範圍之腫瘤切除外，適度之骨切除與頸部廓清為屬必要。此外合併罹患黏膜下纖維化之患者，有較高之手術併發症與第二部位腫瘤，且預後明顯較無罹患者差，因此應於手術前一併考應此因素。

關鍵字

後臼齒三角區 ； 鱗狀細胞癌

並列摘要

Retromolar trigone was a area that were boundary by maxillary tuberosity, buccal mucosa, anterior tonsillar pillar, mandibular ramus and external oblique ridge. In the area there were covered by mucosa and gingiva, plenty of neurovascular and lymphatic system. Squamous cell carcinoma of this area was easy to invaded the nearby structure, including the bone, tonsil and muscle. Surgical treatment of this area tumor was difficult because of the anatomic structure would interfered the procedure. We reported 21 patients of squamou cell carcinoma of retromolar trigone that received the surgical treatment in our hospital during 1991-1997. In this study we will analysis these patients retrospectively for the factor that would affect the surgery and prognosis. Choice the appropriate surgical approach, more aggressive tumor resection and osteotomy was emphysised in this study. Concomitant submucosal fibrosis will increase the risk of complication, and it will be considered during reconstruction too.