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題 名 | 贋復重建硬腭腫瘤手術後腭咽帆關閉不全--病例報告=Prosthetic Rehabilitation of Velopharyngeal Insufficiency Which Occurred after Hard Palate Tumor Surgery--A Case Report |
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作 者 | 賴冠達; 鄭中孝; 黃穰基; | 書刊名 | 臺灣口腔顎面外科學會雜誌 |
卷 期 | 23:1 2012.03[民101.03] |
頁 次 | 頁75-85 |
分類號 | 416.954 |
關鍵詞 | 硬腭缺陷; 腭咽帆關閉不全; 閉孔器贋復體; Hard palate defect; Velopharyngeal insufficiency; Obturator; |
語 文 | 中文(Chinese) |
中文摘要 | 外科手術切除上顎腫瘤時,往往會形成一手術缺陷區造成口鼻相通,進而影響患者的咀嚼、發音、吞嚥等生理性功能,甚至形成腭咽帆關閉不全,應盡早給予重建.治療方式分為手術重建或以閉孔氣贋復物重建,然而該選擇適當的修補手術或是採用贋復體重建,在實證醫學上並沒有嚴謹的適應症規定.本文主要敘述一利用贋復重建因局部皮瓣手術重建硬腭缺陷區後形成腭咽帆關閉不全的困難病例.推究其原因可能是腫瘤手術缺陷區接近軟硬腭交接處,加上術後患者不願配戴臨時閉孔器,使得局部皮瓣修補手術後疤痕收縮,造成懸雍垂附近發生腭咽帆關閉不全,反而增加了最終贋復製作的困難.因此,選用何種重建上顎缺陷區的治療方式應作詳盡地術前評估,同時考量患者配戴臨時性/最終閉孔器的意願,以期達到一個理想的治療效果. |
英文摘要 | The surgical defects from maxillary tumor surgery would result in oro-nasal or oroantral communication occassionally. It would hinder the normal physiological functions including mastication, phonation, and swallowing; furthermore it may lead to velopharyngeal insufficiency. Therefore, restoring these functions should be as soon as possible. Treatment options for these patients comprise surgical reconstruction and obturator prosthetic rehabilitation. However, from the viewpoint of evidence-based medicine, there is no strong treatment indication to choose about surgical repair or prosthetic rehabilitation. This article mainly reported a difficult case who received prosthetic rehabilitation for velopharyngeal insufficiency which occurred after hard palate tumor resection. The possible cause is that the surgical defect was near the border between hard and soft palate, and the patient did not follow the instruction to wear the interim obturator. In addition, tense scar contraction occurred to contribute to velopharyngeal insufficiency after surgery. Although it increased the difficulties for final prostheses fabrication, the defect was repaired using two-staged prosthetic obturator. In conclusion, we should make comprehensive pre-operation evaluation, including the patient's will to wear interim/definitive obturator, and about choosing which kind of treatment for maxillary defects in order to get an ideal treatment outcome. |
本系統中英文摘要資訊取自各篇刊載內容。