頸部蛤蟆腫：八病例報告

蛤蟆腫是指因為唾液腺分泌物外滲所造成的口底囊腫。當囊腫發生在頸部時，稱之為頸部蛤蟆腫（cervical or plunging ranula）。頸部蛤蟆腫是一種較為罕見的疾病，雖然已經有許多病例報告，但其病灶來源是舌下腺還是顎下腺以及治療方式仍缺乏完整的研究與一致的看法。本文是報告過去十九年在高雄醫學大學口腔顎面外科所處置的八例頸部蛤蟆腫病例，並討論其病灶來源及治療方法。其中三例是經由頸部切除囊腫及顎下腺：結果有兩例治癒，一例復發。另外的五例在術中發現舌下腺穿過下顎舌骨肌進入顎下間隙而與囊腫沾黏，其中三例除摘除囊腫及顎下腺外，同時將舌下腺全部切除，另外兩例則只做部份切除，部份切除舌下腺的病例則有一例復發。總計八病例，只有一例同時伴有口底腫脹（12.5%），與過去文獻提出的病例報告，79%同時伴有口底腫脹，有很大的差異。因此我們認為舌下腺與顎下腺都有可能是造成頸部蛤蟆腫的原因。開刀時，依病人是否有口底腫脹及囊腫沾粘在哪一個腺體，而此腺體一併切除，如果兩個腺體都有沾粘則以全部切除為宜。

關鍵字

頸部蛤蟆腫；假性囊腫；顎下腺；舌下腺

並列摘要

The term “ranula” can be either mucus retetion cyst or more common extravasation pseudocyst which is confined to the floor of the mouth. A plunging ranula refers to those that extends beyond the sublingular space and involves the submandibular space and adjacent structure. It may appear as a submandibular mass without visible intraoral involvement, in which case the dignosis is more difficult. Uncertainly with regard to the exact aetiology and pathogenesis of the plunging ranula has resulted in controversies in surgical management. We have treated eight patients with a plunging ranula underwent surgery via a cervical approach in KMUHOMS during the past 19 years. In three cases, excision of the cyst and submandibular gland were done, one recurrence was observed. In another five, the ranula passing through the mylohyoid muscle. Total sublingual gland excision was performed in three cases. And subtotal excision was done in two cases, in which, one recurrence was noted. In the recurrent cases, intraoral excision of the sublingual gland and drainage of the cyst for the salvage surgery. We presented our experience in eight cases with plunging ranula for further study. In our opinion, cervical ranula may arise from sublingual or submandibular gland. So, we excised the gland that adhered to the cyst. If the cyst adhered both of the salivary glands, we excised them all.

並列關鍵字

plunging ranula ； pseudocyst ； submandibular gland ； sublingual gland

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頸部蛤蟆腫：八病例報告

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