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題 名 | 口腔黏膜下纖維化症之臨床療法評估=Clinical Evaluation of Different Treatment Methods for Oral Submucous Fibrosis |
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作 者 | 賴德榮; | 書刊名 | 鼎友 |
卷 期 | 6:4 1996.06[民85.06] |
頁 次 | 頁84-92 |
專 輯 | 口腔內科專集 |
分類號 | 416.94 |
關鍵詞 | 口腔黏膜下纖維化症; Oral submucous fibrosis; OSF; |
語 文 | 中文(Chinese) |
中文摘要 | 口腔黏膜下纖維化症(Oral submucous fibrosis, OSF)之主要特徵包括口腔灼熱感、黏膜呈現不等之蒼白與僵硬而導致牙關緊鎖等現象。以往有關此症之治療報告指出不管採用保守性、外科性、抑或物理治療雖可達到一些療效但不臻理想。本文除了回顧學者們所提之多種療法外,進而提出作者根據十多年來實際治療此症之臨床經驗與評估結果供諸位參考。所有150位(1982-1991)羅患此症之患者依作者之治療篩選分類,以患者求診時之主訴症狀與病灶之嚴重度並參考其最大張口度(上下顎門牙間距)20亳米範圍上下而分類成兩大組,分別接受內科性口服維他命B群複方與促進末梢血液循環之錠劑或口內黏膜下局部注射藥物(如類固醇與玻尿酸�t等)與外科切除纖維性病灶併做移植體如皮膚、頰脂墊(buccal fat pad)、新鮮人類羊膜(amnion)等。所有患者於治療開始即接受全口洗牙與口腔衛生教育勸導並戒除咀嚼檳榔。 經過兩年以上之追蹤評估結果顯示前者於症狀改善如灼熱感、黏膜蒼白度等,具有令人滿意之療效,而後者即所有接受開刀手術之患者均能獲得較其原來求診時張口度還大之改善情況;由(表2)可發現追蹤兩年後之三種移植手術中,在縮小張口度大約5-10mm比較上,以羊膜(62%)之患者最為顯著,其次為皮膚(50%)與頰側脂肪墊(38%),意即頰脂墊具有最少之傷口收縮情況。目前國內外文獻,尚無從查到有關此三種移植體做為口腔黏膜缺陷傷口之重建,於術後追蹤人探討傷口收縮之情形。 人類羊膜具無毒性、無抗原性及特殊黏著性之本質,頗適合口內黏膜下移植,唯應注意的是對於嚴重糖尿病與嗜煙病人則不宜採用此法,否則傷口之癒合與移植體之存活將受影響。因此,以羊膜取代傳統性皮膚移植有其臨床上之應用價值。 作者運用頰側脂肪墊於口腔黏膜下纖維化症之病灶,尤其針對咽門柱(Pillar)區纖維帶切除後之傷口缺陷(全層厚度)藉由它之往下估扇形移植覆蓋頰側傷口後2/3處(直徑以不超過40mm)最為理想。它同樣與羊膜般可減少患者因取皮之第二傷口等之不適與不便。 原則上作者建議患者接受本療法時,治療前、後除了須完全戒除嗜嚼檳榔習癖外,於治療中及爾後亦須配合日常自我加強性張口運動,此兩項為治療本症所必須遵照之事項。作者所提治療原則,經過多年來之評估與考驗,大致上對於此類患者提供了實質之幫助,舉凡他(她)們的主訴問題包括症狀之改善與增加張口度等均能獲致相當程度之療效。 |
英文摘要 | The management of early and advanced cases of oral submucous fibrosis (OSF) over the past 10 years was presented. An efective regement for the treatment of this disease was proposed as well. Over a 10-year period (1982-1991), a total of 150 patients divided intotwo groups with vaying degrees of OSF were treated by two alternative therapies: either (1) medically with (a) conservative oral administration of vitamin B-complex, buflomedial hydrochloride and topical triamcinolone acetonide 0.1%, or with (b) conventional submucosal injections of a combination of dexamethasone and hyaluronidase of (c)with both (a) and (b), or (2)surgically by the excision of fibrotic tissues and covering the defect with split-thick-ness skin, fresh human amnion, and buccal fat pad (BFP)grafts. Treatment was chosen according to the stage of clinical progression to gain maximal interincisal distance (ID). The cases were followed up by monthly examinations for at least two years, or then possible even longer. A combination of (a) and (b) medical treatment was satisfactory in cased of mild impairment in ID of > 20 mm, but in the long-term it led to symptomatic relief only. Surgical therapy, on the other hand, when accepted by the patients led to a significant impovement of trismus in cases of severe limitation of ID of<20 mm. Following this strategy. an additional ID increase was observed in all patients. BFP grafting was particularly successful in diminishing scars after two years as compared with the other two grafts. Together with acessation of the betel quid chewing habit befor and after therapy, these treatment regimens combined with daily mouth opening exercises were found to be necessary to properly manage OSF cases in early and advanced stages of progression. |
本系統中英文摘要資訊取自各篇刊載內容。