하악 부위에 병발된 구강 편평 상피 세포암종에 대한 절제술부터 재건까지의 연속 치료방식: 증례 보고 및 문헌고찰
Sequential Treatment from Mandibulectomy to Reconstruction on Mandibular Oral Squamous Cell Carcinoma Patients: Two Cases Report and Literature Review
권진주, 마윤희, 황대석, 유미현, 김욱규,
소속 상세정보
권진주 ( Kwon Jin-Ju ) - Pusan National University School of Dentistry Department of Oral and Maxillofacial Surgery
마윤희 ( Ma Yoon-Hee ) - Pusan National University School of Dentistry Department of Oral and Maxillofacial Surgery
황대석 ( Hwang Dae-Seok ) - Pusan National University School of Dentistry Department of Oral and Maxillofacial Surgery
유미현 ( Ryu Mi-Heon ) - Pusan National University School of Dentistry Department of Oral Pathology
김욱규 ( Kim Uk-Kyu ) - Pusan National University School of Dentistry Department of Oral and Maxillofacial Surgery
Abstract
Worldwide, oral cancer accounts for 2%?4% of all cancer cases. It is estimated that more of 90% of all oral neoplasms are oral squamous cell carcinoma (OSCC). The aims of this study were to evaluate follow-up outcomes in patients with OSCC invading the mandibular body bone who underwent primary radical resection and reconstructive surgery by fibular free flap or CAD-CAM T-mesh with pathological study on two cases. In this article, two cases of mandibular reconstruction in patients with OSCC invading the mandibular body bone are reported. A 68-year-old male patient visited the authors’ clinic with pain on the left mandibular region. After wide excision and segmental mandibulectomy on the mandibular OSCC, a enterocutaneous fibular free flap from right leg was used to cover the intraoral mucosal defect. The other 51-year-old female patient visited the authors’ clinic with pain on the right mandibular region. After wide excision and segmental mandibulectomy on the mandibular OSCC, reconstruction was done with a reconstruction plate and a fibula free flap from right leg. Unfortunately, fibular free flap was lost due to infection of the flap at post-operative 1month, secondary reconstruction using a custom-made type T-mesh and iliac PCBM was done to repair on the mandibular defect after four years postoperatively. The customized CAD-CAM T-mesh was made prior to the operation according to mirror image of remained jaw. Patients with OSCC invading the mandibular body bone are required an accurate segmental mandibulectomy immediate reconstructive surgery with various methods and followed by adjuvant radiation with or without chemotherapy in order to improve the quality of life through the restoration of the oral function and esthetics after surgery. Postoperative CCRT was determined according to the final pathologic findings such as lymph node metastasis and main lesion free margin safety, and this has an essential relationship in the prognosis of postoperative recurrence. We reviewed reliable treatment options on two patients of OSCC in mandible with pathologic findings.
키워드
Oral squamous cell carcinoma(OSCC); Mandibular reconstruction; Fibular free flap; Titanium-mesh; CAD-CAM
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