下顎幼年性骨化纖維瘤合併動脈瘤性骨囊腫－病例報告

Juvenile Ossifying Fibroma with Aneurysmal Bone Cyst of Mandible: A Case Report

吳伯璋(Buor-Chang Wu) ； 陳玉昆(Yuk-Kwen Chen) ； 黃逸岳(I-Yueh Huang) ； 賴聖宗(Sheng-Tsung Lai)

《中華民國口腔顎面外科學會雜誌》 16卷2期 (2005/09) Pp. 166-178

https://doi.org/10.7104/CJOMS.200509.0166

摘要

幼年性骨化纖維瘤(juvenile ossifying fibroma, JOF)為一頭頸部罕見之腫瘤，多發於兒童及年輕人，無性別上之差異，若發生於顎骨則上顎略多於下顎，特性為生長快速，臨床上會造成患處無痛性的腫賬，放射線影像為周界清晰，單腔室或多腔室放射透過性有時合併中央放射不透過性之小塊。動脈瘤性骨囊腫(aneurysmal bone cyst, ABC)則常發生於四肢骨及脊柱，顎骨的病例僅佔了2%，下顎稍多，亦多發於年輕人，也無性別上之差異，通常為生長快速並造成患處疼痛或其他不適，放射線影像為周界清晰，單腔室或多腔室放射透過性之特性。在顏面骨，幼年性骨化纖維瘤合併動脈瘤性骨囊腫則十分罕見，文獻紀錄以上顎發生者稍多。本病例為－21歲之男性，在19歲時因為左下顎骨角區腫大在某醫院接受外科手術處理，術後病理報告為骨化纖維瘤，因為復發的腫脹而來本院尋求治療，臨床檢查並無疼痛及下唇區感覺異常的問題，放射線影像為周界清晰，多腔室放射透過性合併中央放射不透過性之不規則小塊，手術方式為從口外顎下切線，做下顎骨片段式切除，並以腸骨脊海綿骨移植修補骨缺損加以顎間固定六週，術後傷口恢復及癒合良好，顎骨關係穩定無咬合異常的情況，無張口受限的問題。本病例殊屬罕見，特提出報告及相關文獻回顧。

關鍵字

幼年性骨化纖維瘤 ； 動脈瘤性骨囊腫 ； 骨化纖維瘤 ； 腸骨脊骨移植

並列摘要

The juvenile ossi1, ring fibroma (JOF) is an uncommon neoplasm in head and neck. It occurs predominantly in maxilla of child and young adult without significant sexual predilection. Clinically it develops in a rapid, persistent growth and causes in facial asymmetry. It shows well-demarcated, multilocular or unilocular radiolucency but contains central radiopacities in some cases. The aneurysmal bone cyst (ABC) occurs most commonly in long bone or vertebral column and only 2% in jaws from reported cases. It occurs predominantly in mandible of young adult without significant sexual predilection. It also develops in rapid swelling and pain. Radiographic study shows well-demarcated, unilocular or multilocular radiolucent lesion. Cases of JOF combined ABC are very rare in jaw bone and most of them occurred in maxilla. Here we present a case of 21 year-old male who suffered from recurrent swelling in left side of mandible which had received surgery for ossifying fibroma in another hospital when he was 19 years old. Obvious facial asymmetry was noted but no sensory dysfunctions were detected. The lesion showed well-demarcated, multilocular radiolucency but radiopacity centrally. We applied segmental resection via extra-oral approach and reconstructed with anterior iliac crest bone graft. After removal of MMF in six week, the wound healed well and joint function was good without malocclusion. After follow-up of one year, no recurrences were noted. He also got good esthetics although receiving aggressive treatment.

並列關鍵字

juvenile ossifying fibroma ； aneurysmal bone cyst ； ossifying fibroma ； iliac crest bone graft