- 期刊
腓骨肌皮瓣加上金屬關節頭重建廣泛切除之復發性下顎造釉細胞瘤－病例報告
The Use of Fibular Osteoseptocutaneous Flap and Condylar Prosthesis for Mandible Reconstruction after Radical Resection of Recurrent Ameloblastoma-Case Report
摘要
造釉細胞瘤雖是良性腫瘤，但具有侵襲性及復發率高，故廣泛切除是治療方式之一，然而術後之重建將是更大的挑戰。本文報告一45歲女性病例，經兩次保守性手術後，其左側下顎造釉細胞瘤仍復發，腫瘤延續到喙突(coronoid process)及髁頭(condylar head)，並擴展到顳下間隙(infratemporal space)。手術方法是由下顎骨邊緣切線向上翻開皮瓣，將喙突及髁頭全部摘除，再以重建骨板外加人工關節頭，重建下顎骨外型。接下來取左小腿腓骨皮瓣，並植入兩顆牙科植體後再整體固定於重建骨板上，然後並取腓腸神經縫合於頦神經及下齒槽神經切端。術後三個月，顏面對稱，面部疤痕不明顯，左下唇感覺大部分已恢復，咬合穩定且開口度達30 mm。病患對手術結果滿意。討論：造釉細胞瘤若僅以刮除方式治療，其復發機會高。本病例利用重建骨板外加人工關節頭，再取腓骨皮瓣並同時在口外操作植入牙科植體，整個術式簡單且容易調整，術後不但能維持患者的外觀與功能之外，手術成功率很高。
並列摘要
Ameloblastoma is a benign jaw-bone tumor, which has high recurrent rate if inadequately resected. Reconstruction of large defects of the mandible is challenging. This article reports a forty-five year-old female patient who had recurrent ameloblastoma after received conservative operation. The tumor involved the mandibular body, condylar head, coronoid process and extended into the infratemporal space. Radical resection via a submandibular Risdon incision was followed by immediate reconstruction. A reconstruction plate connected to an artificial condylar prosthesis was inserted into the condylar fossa. The fibular flap was harvested with subsequent installation of two dental implants and fixed to the reconstruction plate. Three months after surgery the patient was satisfied with the result of surgery. Facial symmetry, lip sensation, occlusion and the degree of mouth opening were all acceptable. Artificial condylar head prosthesis and free fibula osteoseptocutaneous flap can provide a good aesthetic and function. Simultaneous installation of dental implants can be performed on the side table, which is a simple and reliable method.
延伸閱讀
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