刮治＋自体骨移植术治疗牙源性角化囊肿（附14例报告）

本文总结了１４例应用刮治和自体骨移植术治疗大型牙源性角化囊肿的方法，１４例植骨均成活，４例术后囊肿复发，再次手术，指出：与骨断切除治疗大型角化囊肿的方法比较，此法最大的优点是有利于保持患者面容和咀嚼功能，并对大型角化囊肿的手术原则，自体骨移植问题及手术注意事项进行了讨论。     

A comparative immunohistochemical analysis of cortactin in orthokeratinized odontogenic cyst (OOC), sporadic odontogenic keratocyst (OKC), and syndromic OKC

ObjectivesTo evaluate and compare the immunohistochemical expression of cortactin in the epithelial lining of orthokeratinized odontogenic cyst (OOC), sporadic odontogenic keratocyst (OKC), and syndromic OKC.MethodsFormalin-fixed paraffin-embedded tissue blocks of histopathologically diagnosed cases of OOC, OKC, syndromic OKC, normal buccal mucosa (NBM), and oral squamous cell carcinoma (OSCC) were examined for immunohistochemical expression of cortactin. Clear brown cytoplasmic and membranous staining was considered positive.ResultsA statistically significant difference was observed between OOC and syndromic OKC (p < 0.001), as well as between sporadic OKC and syndromic OKC (p < 0.001). Although not statistically significant, the expression of cortactin was slightly higher in the basal layer of NBM (mean = 0.47), OOC (mean = 0.27), sporadic OKC (mean = 0.47) syndromic OKC (mean = 1.53), and OSCC (mean = 0.67) than in the parabasal layers of NBM (mean = 0.27), OOC (mean = 0.20), sporadic OKC (mean = 0.47), syndromic OKC (mean = 1.27), and OSCC (mean = 0.60).ConclusionThe expression of cortactin in the basal layer may suggest the formation of invadopodia in the basal layer where the invasion mechanism occurs. This finding is further supported by the higher localization of cortactin in areas of epithelial budding and daughter cysts in syndromic OKC, thereby reaffirming its possible association with recurrence.     

下颌骨牙源性角化囊肿的X线诊断与鉴别诊断(附52例分析)

目的　分析牙源性角化囊肿的临床与X线特点 ,提高对本病的X线诊断与鉴别诊断的能力。方法　 5 2例术前均行颌骨X线正位、侧位摄片 ,其中 2 6例加照颌骨曲面体层摄影。结果　 5 2例均经手术病理证实为颌骨牙源性角化囊肿 ,术前确诊 44例 ,误诊 8例 ,诊断准确率为 84.6%。术后随访 5 2例 ,2 4例复发 ,占 46.1%。结论　复发率高 ,侵蚀性强 ,为其临床特点。X线特点 :单房、多房和多发 ,以多房居多     

牙源性角化囊肿的临床与X线诊断（附26例分析）

本文报告了经手术、病理证实的２６例牙源性角化囊肿，着重分析了其临床特点与Ｘ线表现，提出了本病的Ｘ线诊断依据：①单房不含牙的牙源性囊肿，囊内不含死髓牙的根尖者。②多房不含牙的牙源性囊肿，房的大小、形态相似，并有沿颌骨长轴发展趋向者。③单或多房含牙的牙源性囊肿，所含牙齿不具备真正含齿囊肿特点者。④多发性颌骨囊肿，房的大小、形态及部位有对称分布倾向者。     

Odontogenic Epithelium: Immunolabeling of Ki-67, EGFR and Survivin in Pericoronal Follicles, Dentigerous Cysts and Keratocystic Odontogenic Tumors

The aim of this study was to evaluate the biological profile of odontogenic epithelium by immunolabeling of epidermal growth factor receptor (EGFR), Ki-67 and survivin in keratocystic odontogenic tumors (KOT), dentigerous cysts (DC), and pericoronal follicles (PF). Immunohistochemical analysis was performed in 13 KOTs, 14 DCs and 9 PFs. Immunolabeling was analyzed in the basal and suprabasal layers of KOTs and DCs, and in the islands of odontogenic epithelium and/or reduced enamel epithelium of PFs. KOTs showed the highest proliferation rate among the three groups, mainly in suprabasal layers. EGFR immunolabeling was observed mainly in the cytoplasm in basal and suprabasal layers of KOTs and in the suprabasal layer of DCs. Immunolabeling in both membrane and cytoplasm was greater in PFs. In PFs, membrane-only staining was observed. Survivin immunolabeling showed a greater percentage of positive cells (scoring +++) in the suprabasal layer of KOTs. In DCs, both layers showed similar percentages of cells scoring +++; PFs showed the highest percentage of these cells. In KOTs, epithelial cells showed stimulus-independent neoplastic proliferative characteristics, suggesting the presence of a suprabasal proliferative compartment, maintained by inhibition of apoptosis. In DCs, the basal layer seemed to proliferate in response to stimulus. Although PFs showed low proliferative activity, the expression of EGFR indicates that some cells have a high capacity to respond to stimuli, which could probably explain the origin of odontogenic lesions.     

成釉细胞瘤及牙源性角化囊肿中ICAM-1和VCAM-1的表达

目的探讨细胞间黏附分子-1(ICAM-1)和血管细胞黏附分子-1(VCAM-1)在成釉细胞瘤(AB)及牙源性角化囊肿(OKC)中的表达及其与AB、OKC病理学特征的关系。方法对38例AB、10例OKC、7例正常口腔黏膜(NOM)组织进行免疫组织化学SP法检测,结合病例病理特征进行分析。结果ICAM-1和VCAM-1在AB、OKC和NOM3组表达组间比较,具有显著统计学差异(P<0.05)。ICAM-1在AB中的阳性率达65.2%,显著高于NOM(14.3%),OKC(60.0%)与NOM未见显著统计学差异。VCAM-1在AB中的阳性血管数也显著高于OKC和NOM。ICAM-1和VCAM-1表达与AB的组织病理分型、年龄、性别和发生部位无明显相关性(P>0.05)。结论细胞黏附分子ICAM-1和VCAM-1与AB及OKC的发生、发展及细胞分化与增殖有关。     

Odontogenic Keratocyst: A Case Series of five Patients

During the time period of August 2009 to August 2010, five cases of odontogenic keratocyst were admitted and treated under the care of Department of Otorhinolaryngology, MGMC and RI, Puducherry. Patients came to the ENT OPD with history of swelling in the cheek region, nasal obstruction, numbness in the upper alveolar region. On examination diffuse swelling of size 7 × 3 cm in one patient and size of 5 × 3 cm in two patients, and other two patients size of 6 × 3 cm present in the maxillary region with ill defined borders, the swelling was firm in consistency, no warmth, non tender. Anterior rhinoscopy reveals mass pushing the lateral wall medially, septum pushed to opposite side, mucopus present in nasal cavity, airway reduced on the side of swelling. On examination of oral cavity, a small granulation of size 1.0 × 0.5 cm present in two patient and swelling of size 1.5 × 1.0 cm seen in two patients in vestibule, no swelling in one patient and swelling of size 3 × 2 cm seen in hard palate of two patients and no swelling in three patients, no loosening of tooth seen in all patients. X-ray PNS reveals maxillary hazziness, diagnostic nasal endoscopy reveals lateral wall of nose pushed medially and septum pushed to opposite side. FNAC reveals resolving inflammatory aspirate in one patient, few macrophages seen in two of patients, few keratinocytes seen in two of the patients. CT nose and PNS revealed a large cystic lesion with erosion of anterior and medial wall and floor of maxilla in relation to the root of the last molar tooth in two patients and there is erosion of anterior and medial wall in other three patients. A combined endonasal and external sublabial (Caldwell-luc) approach was performed in four patients and the cystic lesion was removed and in other one patient only endonasal approach was done and cystic lesion was removed and sent for biopsy. Biopsy sent for HPE revealed odontogenic keratocyst.     

Keratocystic Odontogenic Tumor (KCOT/OKC)—Clinical Guidelines for Resection

Purpose

There is no clinical consensus for the treatment of Keratocystic Odontogenic Tumor (KCOT). KCOTs are regarded as benign aggressive tumors and resection is usually considered as a last option. We review the clinical indications for resection based on a case series.

Methods

This is a retrospective study of patients with KCOT treated in a single unit over 17 years. Eighty patients were identified, of which 12 (15 %) underwent resection. The remaining 68 patients were managed by enucleation and curettage, enucleation with peripheral ostectomy, or decompression with secondary enucleation. Data extracted includes gender, age, race, location, previous treatment for the lesion, surgery and outcome/follow up.

Results

Twelve patients treated by resection were identified. The location in the ten benign resected KCOTs was either the mandibular ramus or the posterior maxilla. All mandibular KCOTs exhibited perforation of the lingual plate and involvement of the pterygoid musculature. Seven of the ten cases were recurrent KCOTs and three had no prior treatment. Two had malignant changes in the KCOT and were also resected.

Conclusion

The primary reason for resection of KCOT was involvement of the pterygoid muscles. The presence of malignant change was a separate indication for resection.     

Odontogenic Cysts: Analysis of 680 Cases in Brazil

The purpose of this study was to evaluate the prevalence of 680 odontogenic cysts diagnosed in Porto Alegre, RS, Brazil, and to compare results with findings in the literature. Data of odontogenic cysts diagnosed from 1985 to 2005 were collected from the files of the Oral Pathology Laboratory of Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil, and entered in a standardized form for later comparisons. The most prevalent odontogenic cysts were radicular (72.50%), dentigerous (22.20%) and residual (4.26%) cysts. The mandible of white patients was the anatomic site and ethnic group most frequently affected by this disease. Four of the six types of cysts were more frequent in the second and fourth decades of life, and no significant differences were found between sexes in the diagnosis of odontogenic cysts. In conclusion, the prevalence of odontogenic cysts was similar to that reported in the literature, which shows that inflammatory cysts are the most frequent.