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患者男性,44岁。因右上后牙疼痛,牙龈“脓肿”,于1995年12月到当地卫生所拔除1颗患牙,拔牙后创口不愈合,似“烂肉样”组织生长,经多次就诊并刮除“烂肉”,其创口愈合,但仍有牙痛,且“脓肿”渐长大。1996年2月发现右上腭部膨隆,面部渐出现疼痛,同年3月右眼不自觉流泪,至4月牙痛缓解,而右侧上牙有麻木感,右面部亦隆起变形。1996年6月来我院就诊,“脓肿”行针吸活检并经细胞学检查找到瘤细胞,考虑为涎腺源性恶性肿瘤,遂住院。口腔颌面部检查:右唇颊沟部膨隆,其上距眶下缘2cm,下至唇红缘处,内至鼻翼、鼻翼被推向前上方、鼻孔变形,外达嚼肌前缘,其质中等,周界不清,表面皮肤色泽正常。颌下、颈部淋巴结无肿大。开口型、开口度正常。18～13颊沟变浅,局部骨质膨隆,17缺失,18倾斜,松动Ⅱ度,叩(-),16～11叩麻木,无松动。右上腭部膨隆,约5cm×4cm×2.5cm大小,其内侧越过腭中缝1cm,前至13水平、后越过软硬腭交界0.5cm、外达龈缘,质中等,无压痛。CT扫描示:右侧上颅骨前壁、下壁、内侧壁破坏,上颌窦内软组织肿块影。X线胸片示、心肺隔未见异常。超声波示肝脾无异常。诊断为右上颌骨肿物(腺源性恶性肿物)T_4N_0M。 手术治疗 于1996年6月9日在全麻下行右上颌骨切除术,术中见上颌骨前壁、下壁、内侧壁破坏,肿物穿破?
Male patient, 44 years old. Due to the right upper back tooth pain, gums, “abscess”, in December 1995 to the local health clinic to remove a tooth, after tooth extraction wound healing, like “rotten meat” tissue growth, after repeated visits and curettage “rotten Meat, ”the wound healed, but there is still a toothache, and“ abscess ”grew larger. February 1996 found that the right upper palate bulging, facial gradually appear pain, the same year in March right eye unconscious tears, toothache relieved in April, while the right upper teeth with numbness, right facial uplift deformation. June 1996 came to our hospital, “abscess” line needle biopsy and cytology to find tumor cells, considered salivary gland-derived malignant tumor, then hospitalized. Oral and maxillofacial examination: bulge dorsal lip groove, from the lower edge of the infraorbital margin 2cm, down to lip red edge, within the nose, the nose is pushed forward above the nostril deformation, the front of the chewing muscles, the Medium quality, unclear perimeter, normal skin color. Submandibular and cervical lymph nodes without swelling. Open type, the opening of the normal. 18 ~ 13 cheek groove shallow, local bone bulging, 17 missing, 18 tilt, loosening degree, knocking (-), 16 ~ 11 knock numb, without loosening. Upper right palate bulging, about 5cm × 4cm × 2.5cm size, the medial side across the palate midline 1cm, before the level of 13, after crossing the soft and hard palate 0.5cm, outside the gingival margin, medium quality, no tenderness. CT scan shows: on the right side of the anterior skull, inferior wall, medial wall destruction, maxillary sinus soft tissue mass. X-ray showed no abnormal heart-lung interval. Ultrasound showed no abnormal liver and spleen. Diagnosis of right maxillary tumor (gland-derived malignant tumor) T_4N_0M. Surgical treatment on June 9, 1996 under general anesthesia right maxillary resection, see the anterior, maxillary wall, medial wall destruction, tumor perforation?