4 cm tłuszczak przedsionka jamy ustnej – case study
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4 cm tłuszczak przedsionka jamy ustnej – case study

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Japońscy lekarze zdiagnozowali u 43-letniego pacjenta ok. 40 mm zmianę na błonie śluzowej prawego policzka. Jak podkreślili, była to największa zmiana w tej okolicy, jaką dotychczas mieli okazję leczyć. Diagnostyka wykazała, że jest to tłuszczak łagodny.

Pacjent zgłosił się do Kliniki Chirurgii Jamy Ustnej Szpitala Hironokōgen koło Osaki w Japonii, w związku z obrzękiem twarzy, który towarzyszył mu od 15 lat. U pacjenta nie doszło do porażenia nerwu twarzowego. Jednak do momentu zgłoszenia się do Kliniki zmiana wywoływała dyskomfort podczas jedzenia, problem z przeżuwaniem pokarmu oraz zaburzenia mowy.

Przeprowadzona diagnostyka wykazała owalną, gładką, ruchomą, elastyczną, miękką, uszypułowaną zmianę o średnicy ok. 40 mm, z dobrze zaznaczoną granicą. Wykazano, iż guz zlokalizowany był dokładnie między nabłonkiem a mięśniami gładkimi błony śluzowej policzka. Pomimo tego, że uciskał mięsień policzkowy i powięź, nie miał destrukcyjnego wpływu na niezmienione chorobowo struktury wokół zmiany.

Ponadto pantomogram wskazał na braki w uzębieniu i powstałą w konsekwencji okluzję. Dodatkowo dał również odpowiedź, iż nie doszło do resorpcji kości szczęki.

Początkowo specjaliści diagnozowali zmianę w kierunku m.in. guza neurogennego, tłuszczakomięsaka, guza naczyniowego i guza włóknistego. Jednak badania wykazały, że jest to tłuszczak łagodny. Z uwagi na bardzo długi rozwój guza, brak porażenia nerwów oraz brak nacieku okolic zmiany lekarze zdecydowali o wykonaniu biopsji guza dopiero po operacji.

Guz został wycięty przy użyciu noża elektrycznego

Po wycięciu uszypułowanej zmiany, do którego wykorzystano nóż elektryczny, specjaliści zszyli ranę oraz przekazali bioptat do dalszej analizy. Obserwacja pooperacyjna nie wykazała parestezji czy szczękościsku. Do operacji pacjent został znieczulony miejscowo. Badanie histopatologiczne potwierdziło dojrzałą hiperplastyczną tkankę tłuszczową z naczyniami krwionośnymi oraz hiperplazję tkanki łącznej.

Wykazano również potencjalną przyczynę powstania tłuszczaka. Prawdopodobnie miał na to wpływ zły stan zdrowia jamy ustnej i utrata wielu zębów, co doprowadziło w konsekwencji do przewlekłego drażnienia policzka przez ocalałe zęby. Pacjent pozostawał pod obserwacją pooperacyjną przez rok. Leczenie wówczas przebiegało prawidłowo i nie odnotowano nawrotów.

Źródła:

[1] Y. Sakamoto, G. Oyama, Giant Lipoma Presents from the Buccal Vestibule, Departments of Oral Surgery, Hospital of Hironokōgen, 6512215, Japan, Hindawi. Case Reports in Dentistry, Volume 2020, Article ID 8824548, 4 pages

[2] Dentonet.pl

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