下颌骨囊肿术后骨腔长期未愈2例

颌骨囊肿术后不完全骨愈合偶见于上颌骨,骨缺损区被瘢痕组织部分或全部填充,可能误诊为囊肿复发。本文报道两例下颌升支区牙源性角化囊肿术后长期残留的骨腔。1临床资料病例1,女,49岁。因右侧升支区肿胀不适1月就诊。患者于6年前罹患右下颌骨牙源性角化囊肿,病变累及右下颌升支及下颌体后份(图1a),经口外进路接受囊肿剜除术。近一月感右下颌区肿胀不适。入院后临床检查发现右侧腮     

袋形手术治疗牙源性颌骨囊肿28例临床报告

目的：观察袋形手术治疗牙源性颌骨囊肿的临床效果。方法：复习28例病人的临床资料、X线资料及手术方式。结果：28例患者采用了袋形术进行治疗，并随访1～5年均取得了较为满意的效果。结论：袋形术手术方式成熟，创伤小，根据囊肿的大小、忠区牙齿及囊内含牙的特点选择不同的处理方式，可有效地保持颌骨的连续性及保留牙齿。     

牙源性角化囊肿手术对咀嚼效能的影响

目的：评价下颌骨牙源性角化囊肿手术及可摘部分义齿修复对患者咀嚼效能的影响。方法：通过临床检查和复习X线片明确术前囊肿累及的牙数和术后的缺失牙数,采用吸光度法测定咀嚼效率。对结果进行比较和统计学分析。结果：手术后的平均失牙数下颌骨部分切除术组明显多于囊肿剜除术组和袋形术组;可摘部分义齿修复前及修复后的吸光度值,颌骨切除术组均低于囊肿剜除术和袋形术组（P〈0．01）;囊肿剜除术和颌骨切除术组义齿修复后吸光度值明显提高（P〈0．01）。结论：下颌骨牙源性角化囊肿手术后患者咀嚼效能变化与手术方法或牙缺失数有关。术后可摘部分义齿修复可明显改善患者的咀嚼功能。     

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牙源性囊肿是一组常见于颌骨内的良性病变,一般可根据临床体征和影像学发现作出初步诊断。颌骨牙源性囊肿的手术治疗方法应根据囊肿类型、患者年龄、病变大小及罹患部位等决定。青少年含牙囊肿,预期囊内含牙可自行萌出者,可采用袋形术。病变范围较小的颌骨牙源性囊肿,刮除术为最好的治疗方法。若根尖周囊肿的病源牙可保留,术前应完成根管治疗。术中辅以Carnoy液处理囊壁可减少角化囊肿术后复发。破坏范围大的颌骨牙源性囊肿可选择第一期袋形术,第二期刮除术,有利于减少邻近结构的损伤。颌骨切除术较少应用于治疗颌骨囊肿,主要适应证是病变破坏范围大,多次复发的牙源性角化囊肿。     

老年性骨质疏松症患者下颌骨骨密度的检测分析

目的 研究老年性骨质疏松症患者下颌骨骨密度的改变,探讨下颌骨骨密度改变与全身骨密度改变的相关性.方法 对加例老年性骨质疏松症患者(A组)、40名非骨质疏松症老年志愿者(B组)和40名青年健康志愿者(C组)摄取标准化数字曲面体层X线片;应用计算机图像处理软件对标准化数字曲面体层X线片的下颌骨下缘皮质骨厚度、曲面体层下颌指数、牙槽骨骨密度、牙槽骨骨高度进行测量.使用双能X线吸收骨密度仪测量腰椎及髋关节骨密度.结果 A组下颌骨下缘皮质骨厚度(3.57±0.82)与全身骨密度显著相关(P＜0.05).A组与C组标准化数字曲面体层X线片测量指标(下颌骨下缘皮质骨厚度、曲面体层下颌指数、牙槽骨骨密度、牙槽骨骨高度)差异均具有统计学意义(P＜0.05);A组下颌骨下缘皮质骨厚度(3.57±0.82)与曲面体层下颌指数(0.29±0.06)与B组(下颌骨下缘皮质骨厚度:4.07±0.75,曲面体层下颌指数:0.32±0.07),差异有统计学意义(P＜0.05);B组牙槽骨骨密度(105.40±20.48)与牙槽骨骨高度(10.42±1.82)与C组(牙槽骨骨密度:117.10±22.23,牙槽骨骨高度:11.69±1.63)差异具有统计学意义(P＜0.05).结论 老年性骨质疏松症患者下颌骨下缘皮质骨丢失明显,骨质疏松症对健康牙槽骨没有显著影响,其牙槽骨骨丢失主要为一种增龄性改变.     

袋形术对牙源性角化囊性瘤受累牙牙周骨组织重建的作用

目的:评价和分析袋形术在牙源性角化囊性瘤受累牙牙周骨组织重建的作用。方法:我院收治的采用袋形术联合刮除术治疗的下颌骨大型KCOT患者12例,采用CBCT测得受累牙暴露于囊腔的长度及受累牙根尖区新生骨质厚度,测量曲面断层KCOT病变的的面积,计算受累牙根周骨质覆盖比,统计分析袋形术后每3个月曲面断层病变面积的减少量与相关受累牙根周新生骨厚度的相关性。结果:12例KCOT患者,56颗受累牙中袋形术前根周骨质平均覆盖比为63.69%,袋形术后49颗暴露根尖完全被新生骨质覆盖,其余7颗未完全覆盖的根尖周骨质平均覆盖比例为80.02%,所有受累牙根尖周骨质覆盖比例为97.50%,每3月曲面断层片上病变面积减少量平均为(2.23±0.94)cm²,每3月通过CBCT测得的受累牙根尖区新生骨质的厚度平均为(1.57±0.72)mm,二者呈明显的线性相关,相关系数r=0.908。结论:袋形术后受累牙牙周骨组织在治疗期间可持续成骨并覆盖受累牙根尖暴露区,受累牙根周新生骨质厚度增加与囊腔缩小率成正相关。     

开窗减压术治疗大型牙源性角化囊性瘤的临床研究

目的 :探讨开窗减压术治疗颌骨大型牙源性角化囊性瘤的临床价值。方法 :对22例牙源性角化囊性瘤进行开窗减压术,定期随访,待囊腔直径缩小至1~2 cm或连续观察3个月无明显变化时,行二期囊肿刮除术。结果:开窗减压期为3~24个月,影像学显示囊腔周围新骨再生,颌骨形态改建。二期刮除术后随访6~48个月,无复发病例。结论:开窗减压术是一种安全、有效微创治疗颌骨大型牙源性角化囊性瘤的方法。     

下颌角皮质骨厚度与无牙颌剩余牙槽嵴高度的相关性及其临床意义

本文通过曲面体层Ｘ线摄片测量，对男女两组共４６例无牙颌患者下颌角皮质骨厚度与剩余牙槽嵴高度进行相关性研究，结果发现，下颌角皮质厚度与剩余牙槽高度呈显著正相关关系；男性组下颌角皮质骨厚度及剩余牙槽嵴高度虽均大于女性组，但差异无显著性意义。该结果提示全身性因素对剩余牙槽嵴吸收主要作用。     

开窗减压术联合刮治术治疗下颌骨大型牙源性角化囊性瘤

目的 观察对下颌骨大型牙源性角化囊性瘤采用一期开窗减压术联合二期刮治术术后骨腔的影像学改变,探讨该术式的可行性.方法 下颌骨大型牙源性角化囊性瘤16例,进行一期开窗减压术联合二期刮治术治疗,定期复查曲面断层X线片,观察骨腔的改变.结果 经过8～16个月的观察,所有患者一期手术后病变骨腔逐渐向开窗部位缩小,骨腔密度逐渐增高,最终在开窗部位形成小骨腔;二期手术后约3个月,病变区骨密度与正常下颌骨一致.随访3～8年,所有病例均未见复发.结论 一期开窗减压术联合二期刮治术是治疗大型下颌骨牙源性角化囊性瘤的可行术式.     

囊肿塞在颌骨囊肿治疗中的应用

目的：探讨囊肿塞在袋形术后颌骨囊肿治疗中的临床价值，方法：介绍了囊肿塞的制作，戴入后处理及5例下颌骨牙源性囊肿的临床应用。结果：所有病例中囊肿造口保持通畅，未发现与该装置应用有关的并发症，结论：卡环固位的囊肿塞是大型牙源性囊肿袋形术后维持囊腔引流的一种较好装置。     

Eruption speed and rate of angulation change of a cyst-associated mandibular second premolar after marsupialization of a dentigerous cyst.

The purpose of this study was to investigate the eruption speed and rate of angulation change of a cyst-associated mandibular second premolar after marsupialization of a dentigerous cyst in preadolescents. Premolars on the cyst and noncyst sides and size of the cyst were retrospectively examined with a total of 42 pairs of normalized panoramic radiographs in 20 patients who underwent neither extraction nor orthodontic traction of the cyst-associated mandibular second premolar after marsupialization. Sixteen premolars at the intraosseous eruption stage in a total of 9 preadolescents without cysts were also examined. The eruption speed and rate of angulation change of the cyst-associated mandibular second premolar were significantly faster than those of the premolars without cysts, and significantly correlated with the diminishing rate of the cyst size, which rapidly decreased for the first 3 months after marsupialization. In addition, the eruption speed of the cyst-associated mandibular second premolar correlated with that of the premolar on the noncyst side, and the rate of angulation change inversely correlated with the level of root formation. The results suggest that a cyst-associated permanent tooth erupts more rapidly regardless of the level of root formation and size and type of the cyst, and the abnormally tilted tooth axis improves more rapidly for the first three months after marsupialization of a dentigerous cyst in preadolescents.     

The case of the disappearing third molar.

A mandibular third molar moved into the lower border during a period of several years. When the patient experienced discomfort, an incisional biopsy and marsupialization were performed. Eight months later, adequate bone had regenerated and the molar and remaining cyst structure were removed. Full-mouth and panoramic radiographs would have allowed the dentist to locate the missing molar before surgery was necessary.     

A comparative study of odontogenic keratocysts associated with and not associated with an impacted mandibular third molar

OBJECTIVE: The purpose of this study was to compare odontogenic keratocysts associated with and not associated with an impacted mandibular third molar. STUDY DESIGN: Panoramic radiographs of odontogenic keratocysts associated with impacted mandibular third molars (15 cysts, associated group) were compared with radiographs of odontogenic keratocysts not associated with impacted mandibular third molars (25 cysts, nonassociated group). The radiographic images were analyzed with reference to the patients' age and sex. RESULTS: The mean age of patients in the associated group was lower than that of patients in the nonassociated group. The mean area of the cysts in the associated group was larger than that of those in the nonassociated group. The patients' ages did not significantly correlate to the areas of either kind of cyst. CONCLUSIONS: The odontogenic keratocysts in the associated group had a tendency toward rapid growth in the patients' youth.     

Spontaneous bone regeneration after enucleation of large mandibular cysts: a radiographic computed analysis of 27 consecutive cases.

PURPOSE: This study evaluated the spontaneous bone healing after enucleation of large mandibular cysts subjectively and with a computed analysis of postoperative panoramic radiographs. PATIENTS AND METHODS: Twenty-nine patients had large mandibular cysts treated by surgical enucleation. Postoperative clinical and radiographic examinations were performed at 6, 12, and 24 months in 27 patients. Bone regeneration and reduction of the residual cavities and bone density were evaluated with a computed analysis of preoperative and postoperative panoramic radiographs. A subjective and clinical radiographic evaluation of the healing process also was performed. RESULTS: Uneventful healing and spontaneous filling of the residual cavities was obtained in all cases. The computed analysis of the postoperative radiographs showed mean values of reduction in size of the residual cavity of 12.34% after 6 months, 43.46% after 12 months, and 81.30% after 24 months. The increase in bone density was 37% after 6 months, 48.27% after 12 months, and 91.01% after 24 months. CONCLUSION: Spontaneous bone regeneration can occur in large mandibular cysts without the aid of any filling materials. This simplifies the surgical procedure, decreases the economic and biologic costs, and reduces the risk of postoperative complications.     

Effects of mandibular odontogenic keratocyst surgery and removable partial prostheses on masticatory performance

STATEMENT OF PROBLEM: Surgical treatment of odontogenic keratocysts often results in tooth loss. However, information about the effects of different surgical methods and postoperative prosthetic therapy on masticatory performance is lacking. PURPOSE: The purpose of this study was to compare tooth loss following odontogenic keratocyst treatment by enucleation, segmental mandibulectomy with reconstruction, or marsupialization, and the resultant effect on masticatory performance with and without removable partial dentures (RPDs). MATERIAL AND METHODS: Patients with odontogenic keratocysts of the mandible were treated with either enucleation (n=33), segmental mandibulectomy and immediate autogenous bone reconstruction (n=18), or marsupialization in combination with secondary enucleation (n=9). Clinical and radiographic examinations were used to assess the number of teeth with cyst involvement preoperatively and the number of teeth lost following cyst treatment. Masticatory performance with peanuts was measured after cyst treatment both with and without an RPD. The differences in the number of the teeth involved preoperatively and lost postoperatively were compared among the 3 groups with a chi square test for trend. The absorbance value (reflecting masticatory performance) difference among the 3 groups preprosthesis and postprosthesis was analyzed using a 1-way analysis of variance (ANOVA), respectively. The pre- and postprosthetic comparison was made within each group, and a paired t test was used. Age was compared using 1-way ANOVA among 3 groups. Gender was compared using the chi square test (alpha=.05). RESULTS: Although the average number of teeth involved preoperatively with the cyst was similar among the 3 treatment groups, the number of teeth lost following marsupialization was significantly less than the number lost following enucleation or segmental mandibulectomy. Prior to provision of an RPD, mean masticatory performance (mean absorbance value of 0.36+/-0.08) in subjects receiving segmental mandibulectomy was significantly lower than for subjects receiving enucleation (0.52+/-0.15) or marsupialization (0.89+/-0.12) (P<.01). Provision of an RPD significantly increased masticatory performance in subjects who were treated by enucleation or segmental mandibulectomy (P<.01). CONCLUSION: Masticatory performance following odontogenic keratocyst surgery is related to the number of lost teeth, which is a function of the operative method used. Restoration with an RPD postoperatively may improve masticatory function when multiple teeth are lost following enucleation or segmental mandibulectomy.     

Mandibular metastases from follicular carcinoma of the thyroid gland: a case report

A case of metastatic thyroid carcinoma near the left mandibular ramus with a cyst-like appearance on rotational panoramic radiographs is reported. A 55-year-old woman complained of a continuous sense of incongruity for 3–4 years since extraction of the left mandibular third molar. The lesion, with apparent gingival swelling around the left second molar, was painless and was cyst-like in appearance on plain radiographs. On the basis of the radiological findings, a benign odontogenic tumor was suspected, but computed tomography (CT) showed destruction of the lingual cortical bone with soft tissue invasion to the masticator space. The final histopathological diagnosis was metastatic follicular carcinoma of the thyroid gland. When investigating cyst-like radiolucent lesions with thick sclerotic margins and irregular areas on plain radiographs, we recommend using CT to evaluate the effect of the lesion on cortical bone.     

A radiologic analysis of dentigerous cysts and odontogenic keratocysts associated with a mandibular third molar

OBJECTIVE: The purpose of this study was to discriminate radiographically between dentigerous cysts (DCs) and odontogenic keratocysts (OKCs) associated with a mandibular third molar. STUDY DESIGN: The material consisted of panoramic radiographs of dentigerous cysts (44 patients, 45 cysts) and odontogenic keratocysts (15 patients, 16 cysts), all of which were related to a mandibular third molar. The radiographic images were analyzed with reference to the patients' ages and symptoms. RESULTS: The mean age of patients in the OKC group was less than that of patients in the DC group. The mean area of the cysts in the OKC group was larger than that of those in the DC group. The mean distance from the second to the third molar in the DC group was greater than that in the OKC group. Although there was a significant correlation between the area and distance in the DC and OKC groups, the patients' ages did not significantly correlate to the area and distance of either cyst. CONCLUSIONS: The OKCs had a tendency toward rapid growth in the patient's youth but short movement of a third molar compared with the DCs. The DCs and OKCs do not appear to develop gradually from the period when follicles or dental lamina were formed but arise at various periods randomly.     

Marsupialization inhibits interleukin-1α expression and epithelial cell proliferation in odontogenic keratocysts

BACKGROUND: Marsupialization results in the reduction of odontogenic cyst size. Interleukin-1alpha (IL-1alpha) is thought to play a crucial role for the expansion of odontogenic keratocysts. The aim of this study was to investigate the effects of marsupialization on the expression of IL-1alpha and on the proliferating activity of a lining epithelium in odontogenic keratocysts. METHODS: The concentrations of IL-1alpha, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) in the intracystic fluids of odontogenic keratocysts were measured by the enzyme-linked immunosorbent assay (ELISA). The expression of IL-1alpha mRNA in odontogenic keratocysts was measured before and after marsupialization by in situ hybridization. The expression of IL-1alpha and epithelial cell-proliferating activities in odontogenic keratocysts were also measured by immunohistochemistry using antibodies for human IL-1alpha and Ki-67 antigen, respectively. RESULTS: The intracystic fluid levels of IL-1alpha were significantly higher than those of IL-6 and TNF-alpha in odontogenic keratocysts. In situ hybridization and immunohistochemistry showed that strong expression of IL-1alpha mRNA and protein was mainly detected in the epithelial cells of odontogenic keratocysts. After marsupialization, the signal intensities for IL-1alpha mRNA and protein were significantly decreased. In addition, the Ki-67 labeling index of the epithelial cells was decreased proportionally with the grade of IL-1alpha mRNA expression after the marsupialization. CONCLUSION: Our findings suggest that marsupialization may reduce the size of odontogenic keratocyst by inhibiting IL-1alpha expression and the epithelial cell proliferation.