口腔颌面部结节病14例临床分析

目的：总结分析14例口腔颌面部结节病的诊治经验。方法：回顾分析1993年至2005年期间收治的14例结节病患者的病例资料，所有患者均行手术治疗，术后经病理诊断证实。8例口腔及颌面部单发病变行完整切除，术后予以随访观察。4例病变位于腮腺者，行肿块及腮腺浅叶切除术，保留面神经，术后随访观察。2例多发病变者，先予试验性激素治疗，病变缩小后再行大部切除，术后继续接受激素治疗。随访1个月～10a。结果：14例患者中，男5例．女9例：年龄30～66岁，中位年龄49岁、病变位于唇部5例，腮腺4例（1例双侧腮腺受累），颏部1例，下颌下1例，舌1例，颧部及下颌下1例．同时累及腮腺、下颌下、颏部1例．手术治疗效果良好，1例有上唇结节病患者．术后1年复发，再次手术治疗；1例舌结节病行部分切除，病变持续存在（8a），仍感不适。2例病变广泛者，术后辅以激素治疗．预后良好，无病变复发或进展。结论：口腔颌面部结节病临床少见，多属局部性病变，手术治疗可获良好疗效。对病变广泛者．术后需配合正规激素治疗，并严密随访观察。

Sarcoidosis of the oral and maxillofacial region: Review of 14 consecutive cases

PURPOSE: Sarcoidosis is a multisystematic granulomatous disease in which pulmonary involvement is the most characteristic feature, rarely occurring in the oral and maxillofacial area. This paper is aimed to review the diagnosis and treatment of 14 patients with sarcoidosis in the oral and maxillofacial region. METHODS: The clinical data of 14 cases with sarcoidosis in the oral and maxillofacial region treated during 1993 and 2005 in Ninth People's Hospital (tertiary hospital of Shanghai) were retrospectively analyzed. All the patients underwent surgical therapies, and the diagnosis was proven histopathologically. Eight cases with isolated lesions in the oral cavity and maxillofacial region had complete surgical excision and close follow up postoperatively. Four cases with lesions in the parotid glands underwent resection of the mass and the superficial lobes of the glands with preservation of the facial nerve. The patients were followed up after operation. Two patients with multiple lesions were treated with trial of prednisolone first, and then excision of the masses broadly. Routine corticosteroid treatment was given postoperatively. All the patients were followed up from 1 month to 10 years. RESULTS: Among the 14 cases, 5 were male, 9 were female. The patients' age ranged from 30 to 66 years, with a median of 49 years. The lesions were located in the lips (5), the parotid glands (4, 1 was bilateral), the chin (1), the submandibular region (1), the tongue (1), the zygomatic and submandibular region (1), the parotid gland and chin as well as the submandibular region (1). The results of surgical treatments were satisfactory without major complications. One case with sarcoidosis in the right upper lip recurred 1 year postoperatively and underwent re-operation. One case with sarcoidosis in the tongue underwent local resection, and the lesion persisted for 8 years without progress. Two cases with multiple lesions undergoing surgery and postoperative corticosteroid treatment healed well without progress and recurrence. CONCLUSION: Sarcoidosis was uncommon in oral and maxillofacial region, and most lesions were region-limited without systematic involvement. Surgery alone can achieve satisfactory outcomes for isolated lesions; while for multiple lesions, corticosteroid treatment should be given routinely after operation to hinder the disease spread and progress, with close follow up of the patients at the same time. Supported by Shanghai Leading Academic Discipline Project (Y0203).