勒福一型截骨術移除上顎後方大型複合性齒瘤－病例報告及文獻回顧

齒瘤被定義為發育性異常，為常見的齒源性腫瘤。可分成混合性以及複合性齒瘤兩種。混合性可以見到牙釉質、牙本質、牙骨質及牙髓等組合成類似結構所組成的腫瘤。複合性則由在一起多個看不出來有牙齒外型的鈣化結構組成。目前治療上顎骨齒瘤以考德威爾呂克術式合併外科手術摘除為主。勒福一型截骨術最早見於西元1867年用於切除上顎骨之中的腫瘤，目前最常使用於改善中顏面畸型之手術。本文患者為30歲男性，於牙科診所進行例行性環口顎X光片檢查時，發現於左側上顎骨後方有一邊界完整均質之放射線不透性病灶。頭部電腦斷層發現一大小約為3x2公分的鈣化性質病灶於左側上顎骨隆突處上方。臨床臆斷為複合性齒瘤。後續接受全身麻醉手術，接受勒福一型截骨術移除此骨性腫瘤，術後無明顯併發症。病理診斷為複合性齒瘤。患者術後無出現明顯外觀改變及維持穩定之咬合。本文討論以勒福一型截骨術移除上顎腫瘤之手術技巧，並回顧文獻探討不同手術方式對於處理此部位腫瘤之比較及手術風險。

關鍵字

齒瘤；勒福一型截骨術；考德威爾呂克術式

並列摘要

Odontoma is the most common odontogenic tumors which defined as developmental anomaly. It includes two types, the compound type and complex type odontoma. The compound odontoma consists of composite mass with enamel, dentin, cementum and pulp structure. The complex odontoma is composed of multiple unrecognized calcified structures. Surgical excision with Caldwell-Luc approach is the main treatment of odontoma located in the maxilla nowadays. LeFort I osteotomy of maxilla was originally recorded an approach to remove tumor from the maxilla in 1987, and it is the most used procedure to correct midface defomlities. In our case, a 30-year-old male who found a well-defined margin homogenous radiopaque lesion located in the left posterior maxilla after a routine local clinic examination with panoramic x-ray. The computed tomography showed the calcified lesion in size 3 x 2 cm and location superiorly on the tuberosity of the left maxilla. Clinical diagnosis is complex odontoma. The surgery of LeFort I osteotomy of maxilla and tumor excision was done under the general anesthesia, and no obvious complications after the operation. The final diagnosis is complex odontoma. We discuss the surgical technique of LeFort I osteotomy and review articles to compare different surgical approaches of similar tumor position and surgical risks.

並列關鍵字

Odontoma ； LeFort I osteotomy ； Caldwell-Luc approach

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