下顎骨埋伏智齒拔除後併發慢性骨髓炎－病例報告

根據統計，下顎骨埋伏智齒於複雜性齒切除術術後，發生感染的機率約爲1.7%~2.7%，其中以軟組織感染較爲常見，而單獨發生朴下顎骨深處的骨髓炎，實爲罕見的併發症。本報告提出兩例於接受下顎複雜性齒切除術術後近半年，發生顏面部腫脹及張口困難的病例，臨床檢查其原手術區域均無異常且癒合完全，經診斷發現下顎骨枝遭受慢性骨髓炎侵犯。其中一例爲慢性化膿性骨髓炎，患者臨床表現出反覆面部腫脹合併張口困難，於電腦斷層檢查發現下顎骨支外側皮質骨有骨破壞之區域；另例爲慢性骨髓炎合併增殖性骨膜炎，又稱爲加勒式骨髓炎，於患側表現出持續腫脹合併張口受限，電腦斷層則顯現出患部下顎骨枝不對稱骨增生之病灶。患者於診斷後，接受內視鏡腐骨清除術及骨造碟術合併使用抗生素六週後，定期於門診追蹤，迄今未有復發或不適之現象。本文將提出病例報告，並將就其診斷及治療做一文獻回顧及討論。

關鍵字

內視鏡；骨髓炎；腐骨清除術；智齒

並列摘要

The incidence of infection following complicated odontectomy of impacted mandibular molar was ranging from 1.7 to 2.7%. Compared to the soft tissue infection that is constituted as the most common consequence, deep-seated osteomyelitis of mandible is considered to be a rare post-operative complication. We reported two cases of chronic osteomyelitis developed about 6 months after impacted mandibular molar extraction. Patients visited our clinic with the complaint of intermittent facial swelling with concomitant trismus and pain sensation. The intra-oral examination all demonstrated good wound healing without purulent discharge. Different computed tomographic finding depict two types of osteomyelitis. The one revealed destructive resorption of mandibular ramus was diagnosed as chronic suppurative osteomyelitis and the other one with image pattern of asymmethc proliferation of periosteum was diagnosed as chronic osteomyelitis with proliferative ostitis, also known as Garre's osteomyelitis. Both patients were treated adequately and controlled well with focal sequestrectomy via endoscopic approach and further antibiotics for six weeks after surgical intervention. Since osteomyelitis developed after impacted molar extraction is rare, we presented our experiences toward case management with comprehensive literature review to offer reference in similar clinical scenario.

並列關鍵字

endoscope ； osteomyelitis ； sequestrectomy ； third molar

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下顎骨埋伏智齒拔除後併發慢性骨髓炎－病例報告

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