- 期刊
Unusual Marginal Gingival Squamous Cell Carcinoma Presenting as Localized Periodontitis-A Case Report
以局部牙周病呈現之不尋常邊緣性齒齦鱗狀細胞癌－病例報告
摘要
Gingival squamous cell carcinoma (SCC) is a malignant neoplasm which presents in 10% of diagnosed intraoral carcinomas. Due to the proximity of dentition, it can be misdiagnosed at an early stage as a tooth-related inflammatory condition, such as periodontitis or an endodontic-related disease. In this article, we present a case of marginal gingival SCC that mimicks a periodontal disease in its early presentation. A 64-year-old male complained of a toothache over the lower left posterior area lasting 1 month. The clinical examination revealed deep pockets over the lingual area of teeth 46 and 47 with grade 1 tooth mobility but without gingival swelling or pus discharge. After 3 months of periodontal therapy, tooth 47 was extracted, but the wound was unhealed. An incisional biopsy revealed SCC. Following a systemic workup, a wide excision including segmental mandibulectomy, supraomohyoid neck dissection, and subsequent free fibular flap reconstruction were performed. Postoperative concurrent chemoradiotherapy was also carried out. There were no signs of recurrence nor metastasis in the first postoperative year. Marginal gingival SCC easily mimics localized periodontal disease and can be misdiagnosed. In this instance, dentists play an important role in the early detection of the disease and should be aware of the need to biopsy lesions that do not respond normally to routine therapy.
並列摘要
齒齦鱗狀細胞癌在診斷上占了口腔癌的十分之一，由於鄰近於齒列，臨床上不易與牙齒相關的疾病作鑑別診斷。我們報告一位六十四歲男性患者其診斷為邊緣性齒齦鱗狀細胞癌，疾病初期的臨床表現與牙周病相似。患者來院表示後下方牙齒持續疼痛大約一個月的時間，臨床檢查發現在右下第一第二大臼齒的舌側有較深的牙周囊袋，同時牙齒的搖動度大約是一級，齒齦並沒有明顯的腫脹或是化膿。經過三個月的牙周病治療，右下第二大臼齒被拔除，但其傷口並沒有良好癒合，於是進行切片檢查。其病理報告顯示是鱗狀細胞癌，我們幫病人安排進一步的腫瘤分期檢查並和病人及其家屬討論過後進行手術，手術為腫瘤廣泛性切除合併下顎骨截斷術、肩胛舌骨上淋巴廓清術，最後以腓骨肌皮游離皮瓣重建，術後進行輔助性放化療，術後一年追蹤並沒有發現局部復發或是任何的遠端轉移。邊緣性齒齦鱗狀細胞癌的早期臨床症狀很容易和局部牙周病相混，而導致無法早期發現，因此牙醫師扮演很重要的角色，如果發現病灶與常規的治療反應不符，則需要考量到是否有癌症之可能性，以達到早期診斷早期治療之目標。
延伸閱讀
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