以顎下途徑切除左下顎骨角之根尖囊腫－病例報告

Submandibular Approach for a Radicular Cyst at L't Mandibular Angle Area

高主強(Chu-Chiang Kao) ； 陳遠謙(Michael Y Chen) ； 柯政全(Edward C Ko) ； 陳昭明(Chao-Ming Chen) ； 張加明(Chia-Ming Chang) ； 張佩穎(Pei-Ying Chang)

《中華民國口腔顎面外科學會雜誌》 17卷2期 (2006/09) Pp. 139-149

https://doi.org/10.7104/CJOMS.200609.0139

摘要

針對顎下區域發生不明腫塊的患者，大部分的臨床醫師會先朝唾液腺腫瘤或是由感染所引起的淋巴病變等方向進行鑑別診斷。而本篇報告所提之病例，是一個23歲男性，於民國91年12月30日至本院口腔顎面外科求診，主訴左側臉頰及顎下區域有一微痛、圓形、外皮完整，約3.5×3.0公分的腫塊，存在已經有好幾個月的時間。經由仔細回溯患者的病史，發現患者在腫塊發生的半年前，曾接受左下顎第三大臼齒的蛀洞填補，配合臨床理學檢查及X光片、電腦斷層掃描的發現之後，認為此一腫塊的臨床診斷除了可能為唾液腺腫瘤及淋巴病變之外，亦不能排除它是一個齒源性腫瘤或囊腫的可能性。隨後，患者在全身麻醉下，經顎下途徑切除的過程中，發現該病灶與左側下顎智齒牙根部位緊密連結，根據上述臨床檢查、術中發現及術後病理組識報告，證實為根尖囊腫。

關鍵字

根尖囊腫 ； 顎下途徑 ； 下顎骨角前切跡

並列摘要

Clinicians dealing with an unknown firm submandibular mass have been taught never to forget situations such as salivary gland tumors, chronic sialoadenitis, chronic lymphadenopathy or metastatic tumor...etc in the differential diagnostic list. However, we would like to present a similar clinical situation end up with an insterestingly different, yet simple result. A 23 years old young man came to us on 30/12/02' with chief complaint of a mild painful swelling mass at L't cheek for over months. It's a dome shape firm mass with intact overlying skin and mild tenderness on palpation, measured up to 3.5 cm×3.0 cm in greatest dimension at L't mandibular angle and submandibular area. There's a huge amalgam restoration on occlusal surface of the L't mandibular 3rd molar with obvious secondary decay, hut the adjacent oral mucosa was intact. Panoramic radiograph revealed an exaggerated L't mandibular pre-angular notch with focal interrruption of the lower cortical bone just located at the root apices of the L't mandibular 3rd molar. Computed tomography showed a homogenous mass at the anterio-superficial aspect of the L't submandibular gland but there's no jaw bone expansion. All these findings suggested that there's possibility of being an odontogenic lesion. Surgical extirpation by submandibular approach was performed under general anesthesia. A band of fibrous tissue cord connecting the firm submandibular mass with the root apices of the L't lower 3rd molar was observed during the operation. Accordingly, and as we anticipated pre-operatively, it was a raducular cyst confirmed by the post-operative histo-pathologic findings.

並列關鍵字

Radicular cyst ； Submandibular approach ； Pre-angular notch