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下颌骨口腔癌从下颌骨切除到重建的序贯治疗——病例回顾II:基底样鳞状细胞癌和透明细胞牙源性癌的下颌前部及口底病变

Sequential treatment from mandibulectomy to reconstruction on mandibular oral cancer - Case review II: mandibular anterior and the floor of the mouth lesion of basaloid squamous cell carcinoma and clear cell odontogenic carcinoma.

作者信息

Yang Jae-Young, Hwang Dae-Seok, Kim Uk-Kyu

机构信息

Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea.

出版信息

J Korean Assoc Oral Maxillofac Surg. 2021 Jun 30;47(3):216-223. doi: 10.5125/jkaoms.2021.47.3.216.

Abstract

Preoperative patient analysis for oral cancer involves multiple considerations that are based on multiple factors; these include TNM stages, histopathologic findings, and adjacent anatomical structures. Once the decision is made to excise the lesion, the margin of dissection and its extent should be considered along with the best form of reconstruction and airway management. Treatment methods include surgical resection, radiotherapy, and chemotherapy. Although the combined method of treatment is controversial, surgical resection is considered predominantly, and immediate reconstruction after surgical resection follows. The choice of treatment is dictated by the anticipated functional and esthetic results of treatment and also by the availability of a surgeon with the required expertise. Segmental mandibulectomy with primary reconstruction has been shown to have advantages in both functional and esthetic results. A 52-year-old male patient with basaloid squamous cell carcinoma of the floor of the mouth, and the anterior portion of the mandible was treated with surgical procedures that included segmental mandibulectomy with both supraomohyoid neck dissection (SOHND) at Levels I-III and mandible reconstruction with a left fibula free flap. A 55-year-old male patient with clear cell odontogenic carcinoma of the oral cavity underwent segmental mandibulectomy with both SOHND at Levels I-III and mandible reconstruction with a left fibula free flap. The purpose of this study was to review the anatomic and functional results of patients after immediate reconstruction with a fibula free flap following resection of carcinoma in the anterior portion of the mandible and floor of the mouth.

摘要

口腔癌的术前患者分析涉及基于多种因素的多重考量;这些因素包括TNM分期、组织病理学检查结果以及相邻的解剖结构。一旦决定切除病变,就应考虑切除边缘及其范围,同时还要考虑最佳的重建方式和气道管理。治疗方法包括手术切除、放疗和化疗。尽管联合治疗方法存在争议,但主要考虑手术切除,且手术切除后进行即刻重建。治疗方法的选择取决于预期的治疗功能和美学效果,也取决于具备所需专业知识的外科医生的可获得性。节段性下颌骨切除并一期重建已显示出在功能和美学效果方面均具有优势。一名52岁男性患者,患有口底及下颌骨前部的基底样鳞状细胞癌,接受了包括节段性下颌骨切除、I - III级肩胛舌骨上颈清扫术(SOHND)以及用左腓骨游离皮瓣进行下颌骨重建的手术。一名55岁男性患者,患有口腔透明细胞牙源性癌,接受了节段性下颌骨切除、I - III级SOHND以及用左腓骨游离皮瓣进行下颌骨重建。本研究的目的是回顾下颌骨前部和口底癌切除后采用腓骨游离皮瓣即刻重建患者的解剖和功能结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af1d/8249190/fbe4670093cc/jkaoms-47-3-216-f1.jpg

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