下顎骨纖維性發育不良－病例報告

Fibrous Dysplasia of the Mandible-A Case Report

陳怡睿(Yi-Juai Chen) ； 黃裕峰(Yu-Feng Huang) ； 彭芷瑜(Chih-Yu Peng)

《臺灣口腔顎面外科學會雜誌》 21卷2期 (2010/06) Pp. 156-171

https://doi.org/10.7104/TJOMS.201006.0156

摘要

纖維性發育不良是一良性的髓內纖維骨性疾病。症狀包括骨性疼痛、病理性骨折和骨頭畸形。若病灶影響顱顏骨時，其多骨性的盛行率佔71%~91%，單骨性則佔10%~29%。發生在上顎骨比下顎骨多，而女性的好發比例也比男性高。治療以手術爲主，復發率仍高，但惡性比例較低。本病例爲一女性患者因右下臉頰疼痛腫脹拔除右下顎第一至三大臼齒，但症狀沒有改善，因而轉診至本科。臨床檢查發現右臉骨性腫脹且下顎骨下緣明顯凸起，口內可見右下頓大臼齒區的前庭較淺且頰舌側骨增厚，影像檢查發現右下顎骨有毛玻璃樣的放線不透性影像。顯微鏡下可見變厚的骨小樑且在纖維基質中可看到編織骨和板層骨。綜合臨床與影像的發現，將其診斷爲下顎骨纖維性發育不良。患者接受保守性手術治療後，目前持續於門診追蹤。因疾病復發率高，手術的選擇對外觀的影響大，故提出此病例，並分別闡述其臨床症狀、理學檢查、治療與預後，並回顧相關文獻。

關鍵字

纖維性發育不良

並列摘要

Fibrous dysplasia (FD) is a benign intramedullary fibro-osseous lesion originally. Signs and symptoms of FD include facial pain, headache, bone pain, pathological fractures, bone deformities, cranial asymmetry, facial deformity, tooth displacement, and visual or auditory impairment. When only the cranial and facial bones are affected by FD, the prevalence of the polyostotic craniofacial FD ranges from 71% to 91% and of the monostotic form, from 10% to 29%. Fibrous dysplasia of the jaws affects the maxilla more frequently than the mandible and affects females more frequently than males. Malignant transformation is rare, and is usually precipitated by radiation therapy.
This article reported a female who went to a local dental clinic for swelling and pain over right lower face. Right lower first to third molars were extracted, however, the symptoms and signs persisted. Oral and maxillofacial examination revealed right face bony hard swelling, especially over mandible lower border. Right lower posterior vestibular area was shallow and width of ridge increased. Image examination showed ground-glass characteristic. The histopathologic features revealed bundles of spindle cells arranged in a whorled pattern and multiple immature woven bone trabeculae. Taking together clinical, radiographical and histological features, fibrous dysplasia of the mandible was diagnosed. Regular follow up was arranged after conservative shaving. Because of its high recurrent rate and different surgical concepts, the diagnosis and treatment of this disease were discussed and the literature was reviewed.

並列關鍵字

fibrous dysplasia