以高位邊緣性骨切除術合併咀嚼肌群剝離術治療頰黏膜癌導致之張口受限－病例報告

High Position Marginal Resection and Masticatory Muscle Myotomy for the Treatment of Trismus in Posterior Buccal Carcinoma-A Case Report

楊榮武(Jung-Wu Yang) ； 黃鈺芬(Yu-Fen Huang) ； 康家郡(Chia-Chun Kang) ； 陳威齊(Wei-Chi Chen) ； 蔣維凡(Wei-Fan Chiang)

《臺灣口腔顎面外科學會雜誌》 26卷1期 (2015/03) Pp. 55-63

摘要

牙關緊閉是頭頸癌病人治療後最常見的併發症之一，尤其是原發腫瘤位於口腔後區如頰黏膜、後臼齒三角區、軟腭等部位更容易發生。牙關緊閉會導致病人進食困難、發音障礙、口腔衛生清潔困難、回診檢視困難及增加吸入性肺炎的風險。相關致病因素有：治療前腫瘤侵犯咀嚼肌間隙和繼發性感染造成的咀嚼肌攣縮、黏膜下層纖維化症、黏膜疤痕干擾、和手術及放射治療後的軟組織纖維化等。最常用來治療頭頸癌術後牙關緊閉的方式包括：以壓舌板或機械性設備做張口練習、手術切除肌肉或黏膜纖維束合併或無合併皮瓣修補、手術切除單側或雙側冠狀突等。然而，多數方法介入時機多在牙關緊閉發生後。本文提出一例頰黏膜癌，在腫瘤切除同時以高位邊緣性骨切除術合併咀嚼肌群剝離術治療牙關緊閉症狀，並於術後配合壓舌板張口練習兩週，共計追蹤兩年張口度維持良好之成果報告。

關鍵字

牙關緊閉 ； 頰黏膜癌 ； 高位邊緣性骨切除術 ； 咀嚼肌群剝離術

並列摘要

Trismus, severe mouth open limitation, is a common post-treatment side effect to head and neck cancer patients, especially tumors located on posterior buccal mucosa, retromolar trigone and soft palate. Trismus may compromise with oral intake, speech, oral hygiene care, tumor surveillance, and may increase the risk of aspiration pneumonia. This problem may be caused by preoperative tumor growth into masticatory musculature, oral submucous fibrosis, soft tissue scarring or fibrosis from surgery and irradiation. The most common therapies for trismus are mouth stretching exercises, which were used by tongue depressor plate or mechanical stretching devices such as Therabite, excision of fibrous bands with or without skin grafts repair, and coronoidectomy with single or both sides. However, all of the above strategies are used to rescue the post-treatment side effect to head and neck cancer patients. The aim of this case report is to express the surgical techniques including high-position marginal resection and jaw closing muscle myotomy to treat and to prevent the trismus in a patient with posterior buccal carcinoma. The result of mouth opening was well maintained by wooden tongue depressor stretching for 2 weeks and followed for 2 years.

並列關鍵字

Trismus ； Posterior buccal carcinoma ； High-position marginal resection ； Masticatory muscle myotomy