Smith Aaron, Petersen Dana, Samant Sandeep, Ver Halen Jon P
Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Ave. Ste. 424, Memphis, TN, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Ave. Ste. 424, Memphis, TN, USA.
Am J Otolaryngol. 2014 Nov-Dec;35(6):826-8. doi: 10.1016/j.amjoto.2014.07.004. Epub 2014 Jul 17.
Squamous cell carcinoma is a common entity among adult head and neck cancer patients, with many requiring reconstruction post resection. Conversely, this entity is rare among children with major reconstruction even more unique. This case and the concomitant review of literature highlight the intricacies of pediatric facial reconstruction.
The case described is of a 6-year-old African-American boy with poor dentition and a painful, 1.5 cm epiphytic lesion on the alveolar ridge of the left mandible. Incisional biopsy and computerized tomography were employed to obtain diagnosis and extent of disease. Surgical resection and reconstruction followed.
Incisional biopsy confirmed the diagnosis of squamous cell carcinoma. Maxillofacial computerized tomography confirmed the extent of the mandibular lesion. After interdisciplinary discussion and weighing options with the family, a segmental mandibulectomy, neck dissection, and right fibula free flap reconstruction with titanium 2.0 mm metal plate fixation was performed. Re-examination post-operatively showed complete coverage of the defect and the ability to restore excised dentition.
Squamous cell carcinoma within the pediatric population occurs less often than sarcomas, but may necessitate major reconstruction. Without rigid reconstruction, contracture may result. The current consensus favors microvascular bone reconstruction. However, a lack of consensus exists regarding the timing of dental rehabilitation.
鳞状细胞癌在成年头颈癌患者中很常见，许多患者在切除术后需要进行重建。相反，这种情况在需要进行大型重建的儿童中很少见，甚至更为独特。本病例及相关文献回顾突出了小儿面部重建的复杂性。
所描述的病例是一名6岁的非裔美国男孩，牙列不佳，左下颌牙槽嵴有一个1.5厘米的疼痛性外生性病变。采用切开活检和计算机断层扫描来明确诊断和疾病范围。随后进行了手术切除和重建。
切开活检确诊为鳞状细胞癌。颌面计算机断层扫描确定了下颌病变的范围。在与家属进行多学科讨论并权衡各种选择后，进行了节段性下颌骨切除术、颈部清扫术以及用2.0毫米钛金属板固定的右腓骨游离皮瓣重建术。术后复查显示缺损完全覆盖，并且能够恢复切除的牙列。
小儿人群中的鳞状细胞癌比肉瘤发病率低，但可能需要进行大型重建。如果没有坚固的重建，可能会导致挛缩。目前的共识倾向于微血管骨重建。然而，在牙齿修复的时机方面尚未达成共识。
