- 期刊
Numb Chin Syndrome in Nasopharyngeal Cancer Patients Demonstrated by Bone Scan: Report of Two Cases
鼻咽癌合併Numb Chin症候群之骨骼掃描
摘要
Numb Chin症候群又名mental neuropathy，是以下頷或下唇發生感覺遲鈍或麻木為特徵的一種現象。我們報告兩名已經接受過手術和放射治療的鼻咽癌病患，在下頷附近出現麻木及感覺異常，符合numb chin症候群的現象。全身骨骼掃描發現在下頷附近有MDP聚集增高，經電腦斷層證實為骨轉移。文獻上有關numb chin症候群且骨骼掃描有異常骨轉移的癌症上有乳癌、惡性淋巴癌、肺癌、甲狀腺癌、腎臟癌和白血病，其中又以乳癌最為常見。固有癌症患者併numb chin症候群時，需考慮骨轉移，此時骨骼掃描可協助釐清骨轉移以及規劃治療計畫。但臨床上放射治療前為了避免牙齦壞死，常會先進行拔牙的預防動作，其骨骼掃描亦會表現出相同影像，所以在解讀numb chin症候群的時候必須更謹慎。臨床發現、放射線檢查與牙科治療紀錄都可以協助鑑別診斷。
並列摘要
The numb chin syndrome (NCS), also referred to as mental neuropathy, is characterized by numbness and hypoesthesia confined to the chin and lower lip. We presented two patients with nasopharyngeal cancer (NPC) who had received operation and radiotherapy. Numbness feeling developed around the chin of both patients. The whole body bone scans showed increased (superscript 99m)Tc-MDP uptake around the mandible, which was consistent with bone metastasis. Literatures regarding NCS demonstrated by the bone scan were reviewed. Breast cancer alone accounts the most common cases of NCS in patients with malignancy. Other malignancies associated with the NCS include lymphoma, carcinomas of the lung, thyroid and kidney, and various leukemias. When NCS is presented in patients with malignancy, a whole body bone scan can help in detecting bony metastasis and treatment planning. However, the extraction of the maxillary posterior teeth to prevent dental osteoradionecrosis may cause the same bone scan pattern, interpretation of the picture of numb chin syndrome thus should be cautious. Clinical status, radiographies and dental records are helpful in differential diagnosis.
延伸閱讀
- 黃志仁、梁雲、連熙隆、王重榮、何耀輝、方富民（1994）。鼻咽癌之骨骼轉移分析。放射治療與腫瘤學，1(4)，329-333。https://doi.org/10.6316/TRO/199401(4)329
- 翁德星、黃澤人、蔡森田（2001）。鼻咽橫紋肌肉瘤 — 病例報告。中華民國耳鼻喉科醫學雜誌，36(1)，48-52。https://doi.org/10.6286/2001.36.1.48
- 張遵（1978）。鼻咽癌侵蝕顱底骨之多向斷面攝影硏究。中華放射線醫學雜誌，3(1)，1-7。https://www.airitilibrary.com/Article/Detail?DocID=10188940-197803-3-1-1-7-a
- Chang, Y. K., Pai, P. C., Chen, M. F., Tang, S. G., Chang, J. T., Hong, J. H., & Tsang, N. M. (2000). 罕見病理組織形態鼻咽癌之治療結果. 放射治療與腫瘤學, 7(4), 259-265. https://doi.org/10.6316/TRO/200007(4)259
- Yeh, I. C., Lee, M. Y., Hsia, J. R., Tsai, S. T., Chen, H. H. W., & Lin, J. C. (2012). 鼻咽癌放療後惡性骨肉瘤－病例報告. 放射治療與腫瘤學, 19(2), 161-166. https://doi.org/10.6316/TRO/201219(2)161