巨大下顎造釉細胞瘤切除後以游離腓骨皮瓣重建－病例報告

顎骨的造釉細胞瘤並非很罕見的腫瘤，但巨大的造釉細胞瘤就很少見。因為巨大到侵犯其他重要器官和大血管，手術切除及重建上是非常困難的。本文報告一54歲女性，主訴左臉部腫賬達30年，且在最近兩年內快速變大，但無疼痛。臨床檢查發現下顎骨聯合區至左側顳顎關節區有一15×9×8公分腫脹，左下牙齦區亦有6×6×2公分大小之腫塊。環口攝影檢查顯示左側下顎骨呈放射線透射病灶；電腦斷層發現左下顎骨膨脹、多處皮質骨破壞，並有多個囊腫樣病灶存在其中，病灶範圍上至顱底，下至舌骨。術前病理切片結果為造釉細胞瘤。患者於民國93年7月接受2/3下顎骨切除術並以游離腓骨皮辦及附有人工關節之骨板重建手術缺損區；術中因顱底血管大出血止血非常困難，最後使用纖維素封劑並黏著附近之肌肉方能止血。患者術後門診追蹤6個月，外觀及功能恢復良好，故提出討論。

關鍵字

造釉細胞瘤；游離腓骨皮瓣；纖維素封劑

並列摘要

Ameloblastoma of the jaw is not a rare tumor, but a huge ameloblastoma is relatively uncommon. The surgical excision and the reconstruction are more difficult, because of the invasion to important organs and, large blood vessels. This text shows a 54 years old female has chief complaints with left facial swelling for more than 30 years. The painless swelling of her left face progressed rapidly in the recent 2 years. The clinical examination showed a swelling of left mandible ranging from the symphyseal region to the left TMJ region measured about 15×9×8cm in size. A mass lesion measured about 6×6×2cm in size was also detected over the left lower gingival region. The panoramic radiograph revealed a huge multilocular radiolucet lesion occupied the left side mandible. A huge mass lesion with bony expansion in the left ramus of mandible, left side of the mandibular body with multiple cystic lesions with cyst-fluid level and some heterogeneous enhanced solid portion were revealed from the CT scan. The lesion invaded superiorly to the skull base and inferiorly to the hyoid bone level. Pre-operative biopsy was performed and ameloblastoma was reported. The patient received tumor excision with mandibulectomy and reconstruction with free fibula osteocutaneous flap and a metal plate with allogenic condyle. Massive bleeding from the skull base was noted during operation very difficult to control the bleeding, finally fibrin sealant was used for hemostasis. Patient was continuously follow up in OPD, 6 months after operation, normal function in speech and swallow with a satisfactory esthetic result are noted.

並列關鍵字

Ameloblastoma ； free fibula osteocutaneous flap ； condylar replacement ； fibrin sealant

國際替代計量

巨大下顎造釉細胞瘤切除後以游離腓骨皮瓣重建－病例報告

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