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上颌窦造釉细胞瘤:考虑到高复发风险,采用保守的手术治疗。

Ameloblastoma of the maxillary sinus: conservative surgical management considering high recurrence risk potential.

机构信息

Otorhinolaryngology and Head and Neck Surgery, Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier, Deutschland, Germany

Otorhinolaryngology and Head and Neck Surgery, Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier, Deutschland, Germany.

出版信息

BMJ Case Rep. 2021 May 13;14(5):e241487. doi: 10.1136/bcr-2020-241487.

Abstract

Ameloblastoma (AM) in the maxillary sinus is rare. This benign entity shows locally invasive, destructive and aggressive behaviour and a high rate of recurrence. Therefore, the course of treatment is radical resection. We report the case of a 38-year-old man presenting with signs of recurrent sinusitis in the Ear, Nose and Throat Department. Transnasal flexible endoscopy revealed a cystic mass in the right inferior and middle nasal passage. CT scan showed an obliterated right maxillary sinus with a ballooning effect and pressure atrophy of the lateral sinus wall, without possible differentiation of the middle and low nasal turbinate. The patient was treated with transnasal functional sinus surgery; pathology stated AM. AM in the maxillary sinus is rare, locally destructive and therefore as a gold standard is resected radically to prevent recurrence. We demonstrate a conservative approach; explicitly, we combined a transvestibular and functional endoscopic sinus surgery resection of the AM to maintain function and reduce the possibility of postoperative impairments. Whether the strategy of treatment for AM is conservative, it nonetheless can result in a recurrence-free status. Nevertheless, inclusion into an oncological follow-up-programme with regularly performed MRI and CT is recommended.

摘要

上颌窦造釉细胞瘤(AM)很少见。这种良性肿瘤具有局部侵袭性、破坏性和侵袭性,且复发率较高。因此,治疗方法是根治性切除。我们报告了 1 例 38 岁男性患者,在耳鼻喉科就诊时有复发性鼻窦炎的症状。经鼻内窥镜检查显示右侧中下鼻道有囊性肿块。CT 扫描显示右侧上颌窦闭塞,呈气球样扩张,外侧窦壁受压萎缩,中鼻甲和下鼻甲无法区分。患者接受了经鼻功能性鼻窦手术治疗;病理报告为 AM。上颌窦 AM 少见,局部破坏性强,因此作为金标准,为了防止复发,需要进行根治性切除。我们采用了一种保守的方法;具体来说,我们将经颅外和功能性内窥镜鼻窦手术切除 AM 相结合,以维持功能并降低术后损伤的可能性。无论 AM 的治疗策略是否保守,都可以实现无复发状态。然而,建议患者纳入肿瘤学随访计划,定期进行 MRI 和 CT 检查。

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本文引用的文献

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Maxillary Sinus Ameloblastoma: Transnasal Endoscopic Management.上颌窦成釉细胞瘤:经鼻内镜治疗
Ear Nose Throat J. 2021 Dec;100(10_suppl):908S-912S. doi: 10.1177/0145561320930555. Epub 2020 Jun 2.
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Sinonasal Ameloblastoma.鼻窦成釉细胞瘤
Head Neck Pathol. 2019 Jun;13(2):247-250. doi: 10.1007/s12105-018-0933-3. Epub 2018 May 30.
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Odontogenic tumors: where are we in 2017 ?牙源性肿瘤:2017年我们处于什么阶段?
J Istanb Univ Fac Dent. 2017 Dec 2;51(3 Suppl 1):S10-S30. doi: 10.17096/jiufd.52886. eCollection 2017.
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[Ameloblastoma of the maxillary sinus treated with radiation therapy].[放射治疗上颌窦成釉细胞瘤]
Pan Afr Med J. 2017 Mar 24;26:169. doi: 10.11604/pamj.2017.26.169.8992. eCollection 2017.
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Multi-recurrent invasive ameloblastoma: A surgical challenge.多发性复发性侵袭性成釉细胞瘤:一项手术挑战。
Int J Surg Case Rep. 2017;30:43-45. doi: 10.1016/j.ijscr.2016.11.039. Epub 2016 Nov 21.
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Ameloblastoma: a clinical review and trends in management.成釉细胞瘤:临床综述与治疗趋势
Eur Arch Otorhinolaryngol. 2016 Jul;273(7):1649-61. doi: 10.1007/s00405-015-3631-8. Epub 2015 Apr 30.
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[Inverted sinonasal papillomas. Review of 61 cases].[鼻窦内翻性乳头状瘤。61例病例回顾]
Acta Otorrinolaringol Esp. 2009 Nov-Dec;60(6):402-8. doi: 10.1016/j.otorri.2009.05.002. Epub 2009 Aug 15.

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