Quick-Weller Johanna, Koch Felix, Dinc Nazife, Lescher Stephanie, Baumgarten Peter, Harter Patrick, Scheerer Friedrich, Sader Robert, Seifert Volker, Marquardt Gerhard, Freiman Thomas
Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany.
Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2017 Nov;78(6):582-587. doi: 10.1055/s-0036-1594236. Epub 2016 Dec 30.
Ameloblastomas are a rare tumor entity accounting for only 10% of all odontogenic tumors. They mostly originate from the mandible. Only a few cases are known to grow aggressively and to invade the orbit, nasal cavity, or even the brain. We present the case of a 57-year-old patient who was admitted with a huge tumor involving the nasal cavity, the left maxilla, and the anterior fossa. Histologic diagnosis was made by biopsy. A combined two-stage neurosurgical maxillofacial approach was planned. First the intracranial tumor mass was removed using bifrontal trepanation. A duraplasty was sewn in to cover the brain. In the second procedure, a combined bifrontal and midfacial approach was used by craniofacial plastic surgeons and neurosurgeons. A perisinusoidal tumor mass and retropharyngeal tumor mass was removed up to the skull base. The left orbit was completely exenterated, and a fibular bone-muscle graft was used for palatal, orbital, and facial reconstruction. The facial vein and artery were carefully prepared to feed the bone-muscle graft by end-to-end anastomoses. Ameloblastomas are very rare slow-growing tumors that show a tendency to recur. They are responsible for only 1% of all oral tumors. Their growth can be enormous, and they can extend into sinusoidal cavities, the orbit, and the brain. Complex and extensive palliative surgery can ease the concerns of these patients and prolong their survival.
成釉细胞瘤是一种罕见的肿瘤类型，仅占所有牙源性肿瘤的10%。它们大多起源于下颌骨。已知只有少数病例会侵袭性生长并侵犯眼眶、鼻腔甚至脑部。 我们报告一例57岁患者，因巨大肿瘤累及鼻腔、左上颌骨和前颅窝入院。通过活检进行组织学诊断。计划采用联合两阶段神经外科颌面手术方法。首先，采用双额开颅术切除颅内肿瘤肿块。缝合硬脑膜成形术以覆盖脑部。在第二步手术中，颅面整形外科医生和神经外科医生采用联合双额和中面部手术方法。切除鼻窦周围肿瘤肿块和咽后肿瘤肿块直至颅底。完全切除左眼眶，并使用腓骨骨肌瓣进行腭部、眼眶和面部重建。仔细准备面静脉和动脉，通过端端吻合为骨肌瓣供血。 成釉细胞瘤是非常罕见的生长缓慢的肿瘤，有复发倾向。它们仅占所有口腔肿瘤的1%。其生长范围可能很大，可延伸至鼻窦腔、眼眶和脑部。复杂而广泛的姑息性手术可缓解这些患者的担忧并延长其生存期。
