陽子線治療により生じた2カ所の口蓋瘻孔を口蓋粘骨膜弁と鼻唇溝皮弁で閉鎖し得た1例

A Case in Which Two Palate Fistulas Caused by Proton Beam Therapy Could Be Closed with a Palatal Viscous Membrane Valve and a Nasal Lip Groove Flap

はじめに

　口腔や鼻腔の悪性腫瘍に対して陽子線治療を行った際の合併症として，骨の腐骨化やそれに伴う瘻孔形成がある 1）。今回われわれは，陽子線治療によって生じた2カ所の口蓋瘻孔を，口蓋粘骨膜弁と鼻唇溝皮弁を用いて閉鎖し得た症例を経験した。陽子線治療後に生じた口蓋瘻孔では，周囲組織の血流が著しく障害されている可能性が高い。したがって，その閉鎖にはいかに血流のよい移植組織を用いるかが非常に重要なポイントになると考えられたので，文献的考察を加え報告する。

　A complication of proton therapy for malignant tumors of the oral and nasal cavities is the formation of fistulas due to bone ossification at the site of irradiation and the resulting loss of surrounding tissue. There is concern that palatal fistulas that develop after proton therapy may significantly impair the surrounding blood flow.

　In the present patientʼs case, we were able to close two palatal fistulas caused by complications of proton therapy administered for oral cancer, by using a palatal mucoperiosteal valve on the healthy side and a nasolabial groove valve on the affected side. Normally, nasolabial groove valves cannot be moved to the palate, but in this case, the fistula was closed through the palatal and alveolar bone defects caused by proton beam therapy.