负压吸引联合刮治术治疗牙源性颌骨角化囊肿17例分析

目的评估负压吸引联合刮治术对牙源性颌骨角化囊肿的治疗效果。方法选择近七年我科就诊的17例波及范围较大的颌骨角化囊肿患者,采用囊肿局部开窗负压吸引术进行治疗,术后随访观察2、4、6、12个月,对仍存留的颌骨囊肿行二期囊肿刮治术。结果术后2月,4例囊腔完全消失,囊腔体积缩小平均比率为65%;术后4月,11例囊肿囊腔缩小在75%以上,同期给予了刮治术;术后6月,其余2例缩小平均比率在80%以上,给予囊肿刮治术。所有病例平均治疗时长3.76个月。结论采用负压吸引联合刮治术,可有效治疗颌骨角化囊腔、缩短治疗时长。     

袋形缝合术治疗颌骨巨大角化囊肿体会

颌骨巨大角化囊肿在临床治疗上比较棘手 ,作者对三例“基底细胞痣综合症”合并颌骨巨大角化囊肿患者施行袋形缝合术 ,取得良好效果。认为这种方法手术范围小 ,创伤小 ,保留颌骨 ,术后囊肿迅速缩小 ,为二期根治术创造良好条件。     

392例颌骨角化囊肿临床分析

颌骨牙源性角化囊肿临床较多见，由于其发生发展早期较难发现，对颌骨及牙齿破坏较大。本文对我院1980年～2005年1月收治经病理确诊的颌骨牙源性角化囊肿392例的临床表现、治疗方式作一回顾性分析。     

牙源性角化囊肿囊液和患者血清中sIL-2R水平的初步研究

目的　检测可溶性白细胞介素 2受体 (sIL - 2R)在牙源性角化囊肿患者囊液和血清中的表达 ,探讨其在角化囊肿发生、发展中的作用及临床病理意义。方法　应用双抗体夹心ELISA法对 18例牙源性角化囊肿患者囊液和血清中sIL - 2R进行检测。结果　角化囊肿患者囊液及血清中sIL - 2R水平高于其他颌骨囊肿 ;角化囊肿术后复发患者囊液和血清中sIL - 2R水平高于初发者。结论　角化囊肿囊液中高浓度sIL - 2R存在与角化囊肿具有高复发倾向关系密切     

颌骨角化囊肿——79例临床病理研究

颌骨角化囊肿作为独立性疾病被认识约有20年的历史。以往曾称为胆脂瘤、表皮样囊肿、皮脂腺囊肿以及颌骨始基囊肿。1971年世界卫生组织在对颌骨囊肿的分类中将其称为始基囊肿,其同义名为“角化囊肿”。此分类强调的是组织学特微而不是推测它来自初期釉质器。     

复发性牙源性角化囊肿刮除及冷冻治疗的效果评价

目的：探讨颌骨角化囊肿术后复发的刮除及冷冻治疗效果.方法：1994～2004年间,对10例颌骨角化囊肿术后复发病例,采用囊肿刮除联合冷冻治疗.冷冻方法为直接接触法,即刮除囊壁后,用血管钳将蘸有液氮的棉球送入囊腔,对囊腔骨壁进行冷冻;冷冻时间一般为3～5min,冻融3个周期.治疗后随访5～10a,定期进行临床及X线检查,评价治疗效果和并发症.结果：10例颌骨角化囊肿术后复发患者,经刮除及冷冻治疗后,效果良好,随访期内均无复发.1例因冻伤周围软组织,伤口延期愈合;1例发生下颌骨病理性骨折,经颌间结扎处理,骨折愈合.结论：颌骨角化囊肿术后复发应用刮除及冷冻治疗,远期效果良好,复发率低,减少了以往截骨手术的痛苦,患者容易接受,具有临床推广价值.     

颌骨囊肿100例临床总结

目的:总结颌骨囊肿的诊治经验。方法:回顾分析我科100例颌骨囊肿病例,按性质、大小分类,分别给予不同的治疗方法,对诊治经验进行临床总结。大型囊肿35例(包括5例角化囊肿)均采取开窗减压术加二期刮除术,并非颌骨方块切除;中型囊肿采取囊肿刮除术;小型囊肿采取根管治疗术。结果:5年随访均未复发,治愈率90%以上。结论:在治疗颌骨囊肿时,应根据其类型、病变部位和范围,以及患者的年龄和身体状况选择不同的术式。     

根侧角化囊肿的CK18及基因表达的研究

目的:对根侧角化囊肿与其它角化囊肿衬里上皮细胞角蛋白18(CK18)基因表达是否一致进行探讨。方法:1例根侧角化囊肿、2例颌骨牙源性角化囊肿和1例含牙囊肿的衬里上皮,使用CK18基因探针进行原位杂交,检测CK18 mRNA在衬里上皮细胞层的原位表达;同时进行CK18、PCNA、p53、p21、Bcl-2、Fas/Fas-L、Bax(B-9)、WAF-1、CEA的单克隆抗体免疫组织化学染色。结果:原位杂交法显示CK18 mRNA在根侧角化囊肿的表达为强阳性,其它角化囊肿衬里上皮表现为弱阳性;免疫组化染色结果显示PCNA和Bcl-2在根侧角化囊肿中表达为强阳性,在2例颌骨牙源性角化囊肿表达为弱阳性,在含牙囊肿中有表达;而p53、p21、Fas/Fas-L、CEA在病例中均为阴性表达;Bax(B-9)、WAF-1在1例角化囊肿中表达为弱阳性,在其余3例中均为阴性表达。结论:根侧角化囊肿与其他部位角化囊肿相比较,强阳性表达反映增殖能力的相关蛋白及阴性表达与凋亡有关蛋白、抑癌基因,提示根侧角化囊肿可能比其它部位角化囊肿增殖或复发的潜力更高。     

开窗术治疗牙源性角化囊肿

Philipsen(1956年)提出将具有角化上皮的牙源性囊肿称为“牙源性角化囊肿”。1971年WHO简化囊肿的分类,将始基囊肿和角化囊肿归为一类,但不是所有的始基囊肿都是角化囊肿。牙源性角化囊肿占颌骨囊肿的3％～     

颞下窝软组织外周性角化囊肿1例报告

角化囊肿是口腔颌面部常见的牙源性肿物，多见于颌骨，特别是下颌支和下颌体，罕见在软组织中发生。本文报告1例发生在颞下窝软组织中的外周性角化囊肿，并结合文献，对外周性角化囊肿的组织来源及临床诊断进行了讨论。     

Range and demographics of odontogenic cysts diagnosed in a UK population over a 30-year period

BACKGROUND: The aim of this study was to determine the range of all histologically diagnosed odontogenic cysts along with age range, sex distribution and site of presentation over a 30-year period. METHODS: All entries for odontogenic cysts occurring during 1975-2004 inclusive were retrieved and analysed for demographic data. RESULTS: A total of 55,446 specimens were received, of these 7121 (12.8%) specimens were diagnosed as odontogenic cysts. Radicular cyst was the most common diagnosis (52.3%), followed by dentigerous cyst (18.1) and odontogenic keratocysts (11.6%). CONCLUSIONS: Our study provides demographic data on a large series of odontogenic cysts in a European population. This is one of the largest series reported to date. Cysts such as the paradental cyst have a predilection for certain ages, sexes and sites. Odontogenic keratocysts and glandular odontogenic cysts have a marked propensity to recur as well as behave aggressively. It is essential that such lesions are detected as early as possible to minimize any necessary surgery.     

Neoplastic potential of odontogenic cysts

Odontogenic cysts and tumors are distinct entities and quite a common occurrence in the jaw bones. The lining of odontogenic cysts shows a potential for neoplastic transformation to non odontogenic malignancies like squamous cell carcinoma and mucoepidermoid carcinoma, and odontogenic tumors like ameloblastoma and adenoamatoid odontogenic tumor (AOT). AOT is a benign, epithelial odontogenic tumor, common site being the anterior maxilla. Its origin from a dentigerous cyst and in the mandible is rare. A case of an AOT arising from a dentigerous cyst associated with an impacted permanent mandibular left lateral incisor is reported.     

Validity of conventional surgical treatment methods for mandibular dentigerous cysts. Two case reports

Dentigerous cysts, which are the most commonly seen odontogenic cysts in the jaws, usually expand asymptomatically and extensively. They are surgically eliminated along with the accompanying impacted tooth, because of their destructive nature to the surrounding vital structures, tissues, bone and teeth. The surgical treatment for removing dentigerous cysts includes decompression, marsupialization, enucleation or curettage of the cyst through an extraoral or intraoral approach. Cysts causing tooth displacement and involving loss of bone are treated by marsupialization or decompression, followed by enucleation. In the cases presented here, both patients had enlarged dentigerous cysts in the left mandibular molar region, with an accompanying impacted tooth. Both cases were treated surgically by the enucleation technique alone, without any need for additional autogenous grafts or alloplastic materials to regain integrity of bone structure. They were rehabilitated with dental implants. The implant-retained fixed prostheses functioned well throughout the 24-month evaluation time; and the functional and psychological needs of the patients were provided successfully.     

The incidence, multiple presentation and recurrence of aggressive cysts of the jaws

The incidence, multiple presentation and recurrence rate of aggressive cysts of the jaws is discussed, based on a study of 677 cysts in 651 patients. Cysts that are considered aggressive include: cysts in which carcinoma develops, unicystic ameloblastoma, keratocysts and calcifying odontogenic cysts. Based on literature studies and on our own material, the incidence and multiplicity of these lesions is calculated. Recommendations for treatment include careful preoperative assessment and treatment of suspicious lesions with excision of the overlying mucosa and fixation of the defect with Carnoy's solution. The cyst in which carcinoma develops should be treated as a true malignancy i.e. by resection. Long term follow-up is necessary to eliminate the possibility of recurrence.     

Large radicular cyst in the maxillary sinus

Radicular cysts (RCs) are the most common inflammatory jaw cystic lesions that occur infected and necrotic in teeth pulps. They account for more than 50% of all odontogenic cysts. Radicular cysts cause slowly progressive painless swelling. There are no symptoms until they become large. Enucleating the cyst is recommended with primary treatment. Here we describe a patient with a large RC with maxillary sinus involvement who underwent an endonasal endoscopic approach for complete resection. In conclusion, the endonasal endoscopic approach should be kept in mind for the resection of RC with maxillary sinus involvement because of its minimally invasive characteristics.     

A conservative approach in the management of inflammatory dentigerous cyst in transitional dentition: a case report

Dentigerous cysts are benign odontogenic cysts that develop from the reduced enamel epithelium related to the crown of an unerupted and/or impacted tooth. Inflammatory dentigerous cyst is a variety of dentigerous cyst that is mostly found in the mixed dentition, and the treatment modalities range from enucleation to marsupialization. By extracting the infected primary teeth, opening the cyst, and ensuring continuous drainage, spontaneous eruption of the involved permanent teeth occurs into the dental arch even if they are severely dislocated. The purpose of this report is to describe the successful treatment of a large dentigerous cyst by conservative surgical management.     

How to name it: a rare case of odontogenic cyst

Odontogenic cysts and tumors are well-recognized entities to the specialist oral pathologist and they seldom pose problems in differential diagnosis. This paper deals with an aggressive cystic lesion in the maxilla of a 65-year-old male that was characterized by a large radiographically multilocular lesion and a multicystic pattern microscopically. The categorization of this lesion was complicated by the presence of features suggestive of both glandular odontogenic cyst and cystic ameloblastoma with aggressive histologic phenotypes.     

Adenomatoid Odontogenic Tumor (AOT) Arising from a Dentigerous Cyst: Literature Review and Report of a Case

Adenomatoid odontogenic tumor (AOT) is an uncommon benign tumor of odontogenic origin composed of odontogenic epithelium in a variety of histopathological patterns. These lesions are usually solid but are occasionally cystic. AOT has been reported to occur in association with odontogenic cysts. Very few cases have been described that arise in association with a dentigerous cyst. A systematic search of the English-language medical literature in PubMed and Medline search (keywords adenomatoid odontogenic tumor, dentigerous cyst) data bases revealed only ten such cases.The present case is very unique, exceptional and first of this kind that occurred in the posterior mandible associated with an impacted lower first premolar in a 19-year old female patient. The intraosseous follicular AOT, as this case reported here, frequently resemble dentigerous cysts. There is an uncertainty whether the lining of an associated cyst represents a true dentigerous cyst, cystic change within an AOT or may represent a distinct entity. We believe that this case represents an odontogenic cyst with neoplastic change. Hence, in such cases, the final diagnosis should be made on the basis of histological examination of extensive tissue sampling of entire excised tissue specimen. Further studies to determine whether the AOT derived from an odontogenic cyst could represent a distinct variant are to be done.     

下颌骨多发性含牙囊肿1例报告

含牙囊肿属牙源性囊肿中的一种,又称滤泡囊肿。发生于牙冠或牙根形成之后,在残余釉上皮与牙冠面之间出现液体渗出而形成。多发性含牙囊肿是口腔颌面部的一种少见疾病,同时发生在颌骨的不同区域更是罕见。本文报告1例多发性含牙囊肿病例,并结合相关文献对其病因、病理分型、鉴别诊断和治疗方案等进行探讨。     

The Management of Aggressive Cysts of the Jaws

There are essentially six types of aggressive cysts of the jaws that require special attention, so as to avoid recurrence, or even worse, widespread disease. They include, botryoid cysts, cysts in which carcinoma’s arise, glandular odontogenic cysts, calcifying cystic odontogenic tumour, previously called calcifying odontogenic cyst and unicystic ameloblastoma and keratocystic odontogenic tumor, previously called odontogenic keratocysts. The estimated incidence of these cysts, based on some review studies has been discussed. The main issue, however, when treating a cyst of the jaws is; how sure can one be that the lesion is benign or potentially aggressive? In order to answer this question it is important to know how these cysts commonly present. The clinical presentation, frequency of occurrence and suggested modes of treatment has been addressed.