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由于颌骨内的成牙组织常可作为囊肿和肿瘤的组织来源,因此颌骨是人类骨骼中最好发上皮性囊肿和肿瘤的部位。这类牙源性病损好发于年轻人,可造成颌骨及邻近组织的破坏,导致口腔颌面部外形改变,某些侵袭性病损具有较高的复发倾向,可对患者的生存质量及心理健康造成严重影响。本文着重讨论几种常见的牙源性囊肿与牙源性肿瘤的病理学诊断。     

牙源性肿瘤的WHO(2005)新分类

由于牙源性肿瘤的发生与颌骨和牙发育关系密切,故在其发病、临床病理表现以及生物学行为等方面均具特殊性,是口腔颌面部特有的一类肿瘤,一直备受关注。上世纪40年代以前,几乎所有的牙源性肿瘤被统称为“牙瘤（odontome）”。1946年,Thoma和Goldmann按组织来源将牙源性肿瘤分为上皮性、间叶性和混合性三类,取消了笼统“牙瘤”的概念。基于牙源性肿瘤中可能存在类似于牙发育过程中上皮和间叶组织之间的相互诱导作用,     

286例儿童牙源性肿瘤和囊肿的临床特点分析

牙源性肿瘤和囊肿是口腔常见病 ,临床是以颌骨膨隆 ,牙列畸形或缺失 ,影像学显示颌骨的透亮灶为其特征 [1～ 3 ]。有关牙源性肿瘤和囊肿的各种研究已见报道[4 ,5] ,但尚见有关儿童牙源性肿瘤性和囊肿的报道 ,为此我们特将儿童牙源性肿瘤和囊肿的临床特点作一分析。1　临床资料将我院近 40年间收治并有病理诊断的 1 4岁以下儿童牙源性肿瘤及囊肿共 2 86例 ,按年龄、性别、病理分类、部位等进行分析。2　结果(1 )年龄 (图 1 )　图 1表示 ,儿童牙源性肿瘤和囊肿发病年龄基本呈上升趋势 ,即年龄愈大 ,发病率愈高。肿瘤患儿的平均年龄为 8.2岁。…     

Per[cyst]ent研究兴趣

“Persistent”是持久、不断的意思。标题中用一个错别字来强调笔者长期以来对颌骨“cyst”的偏爱，牙源性角化囊肿（OKC）是一种好发于下颌磨牙升支部的囊肿，与其他牙源性囊肿不同，其生长缺乏自限性，具有某些肿瘤的特征．术后有较高的复发倾向。是口腔颌面部较为特殊的一类疾病。笔者与它“萍水相逢”，“不嫌不弃”，一路走来，苦中作乐，乐在其中。在WHO对头颈部肿瘤的新分类（2005年）中，将其更名为牙源性角化囊性瘤．归属为良性牙源性肿瘤。     

腺牙源性囊肿

腺牙源性囊肿是一种少见的颌骨囊肿。其临床、X线表现有一定的特征性，组织学上明显不同于其它颌骨囊肿。1992年，WHO命名为独立的病变，并归属于发育性牙源性上皮囊肿。多年来，关于该囊肿的组织发生一直是学者们争论的焦点。本文就腺牙源性囊肿的命名演变、组织发生及临床病理等一系列问题作一综述。     

腺牙源性囊肿

腺牙源性囊肿是一种少见的颌骨囊肿。其临床、X线表现有一定的特征性,组织学上明显不同于其它颌骨囊肿。1992年,WHO命名为独立的病变,并归属于发育性牙源性上皮囊肿。多年来,关于该囊肿的组织发生一直是学者们争论的焦点。本文就腺牙源性囊肿的命名演变、组织发生及临床病理等一系列问题作一综述。     

颌骨牙源性角化囊肿的X线诊断：附66例分析

颌骨牙源性角化囊肿的Ｘ线诊断（附６６例分析）南京市口腔医院放射科王铁梅，吴定，廖波在颌骨单囊性、多囊性病变中牙源性角化囊肿甚为常见，其Ｘ线表现影象复杂，常易与其它牙源性囊肿及肿瘤相混淆。且角化囊肿较易复发。因此，为了提高对本病的认识，进一步准确地为临...     

颊黏膜牙源性角化囊肿病例报告及文献回顾

牙源性角化囊肿是一种多发生于颌骨,呈侵袭性生长,且复发率高的牙源性良性病损。一类原发于颌骨外软组织,且具有OKC组织学特点的病变被称为外周性牙源性角化囊肿(peripheral odontogenic keratocyst, POKC)。本文报道1例右颊黏膜POKC,并就临床特点和起因等进行文献回顾。     

牙源性钙化囊肿的诊断与治疗

牙源性钙化囊肿共１８例。原发颌骨内（中央型）１６例。原发颌骨外（外周型）２例。治疗结果：外周型２例局部切除无复发，颌骨内囊肿型局部囊肿刮爬术后均无复发；肿瘤型６例中有３例术后复发，其中２例术后多次复发（１例１２次复发，另１例６次复发），最后局部接受放射治疗后原发灶基本控制。作者对牙源性钙化囊肿的临床病理特点，肿瘤命名及治疗方法进行了讨论。并认为对牙源性钙化囊肿肿瘤型应看作为临界瘤，按低度恶性肿瘤处理原则。复发者应辅助术后放疗，以达到预防局部复发。     

根管治疗应用于颌骨牙源性囊肿受累牙的处理

手术是治疗颌骨牙源性囊肿的主要方法,但颌骨牙源性囊肿的特殊性在于手术方案的制定涉及患区牙的处理,目前对于受累牙的处理国内外并无公认的指南。当受累牙突入颌骨牙源性囊肿的囊腔时,特别是有功能的活髓牙,仍有不同的治疗方案。大量的研究支持受累牙的保守治疗,而根管治疗是将颌骨牙源性囊肿受累牙长期保存于口腔中的一个重要治疗策略。近年来,随着各类材料和器械的更新,根管治疗更加精密、微创,疗效显著提高。文章收集整理近年来的文献,对受累牙评估、根管治疗及根尖切除术在颌骨牙源性囊肿处理方面的应用做一概述。     

A series of 240 odontogenic keratocysts: Should we continue to use the terminology of ‘keratocystic odontogenic tumour’ for the solid variant of odontogenic keratocyst?

Most of the odontogenic keratocysts show an indolent behaviour like non-neoplastic lesions. For this reason, the odontogenic keratocyst was reclassified within the odontogenic cysts category in the WHO 2017 classification. Some odontogenic keratocysts may contain satellite cysts or solid squamoid islands within their wall. Recently, a solid form of odontogenic keratocyst has also been described which is composed entirely of multiple epithelial islands and small cysts in a collagenous stroma. The true nature of this variant is unclear yet.In this article, we present a series of 204 odontogenic keratocyst cases. Clinical and histologic findings of the cases in this series were described. These were also categorised according to the presence of satellite lesions. Additionally, the features of two cases of the solid form of odontogenic keratocysts were compared with those of the previous reports and other histologically similar odontogenic lesions. Current evidence suggests that this variant may be neoplastic and it differs from other odontogenic keratocysts, at least histologically. We believe diagnosing a solid lesion as a cyst is counterintuitive and the term “keratocystic odontogenic tumour” better describes this particular variant.     

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牙源性肿瘤是颌骨最常见病损之一,临床上绝大多数牙源性肿瘤均发生在颌骨内。良性肿瘤多无自觉症状,直至肿瘤生长到一定程度出现颌面部组织膨隆方被发现,早期患者多是在做牙髓治疗或体检照片时无意中发现的,除非继发感染,患者一般没有疼痛等不适感觉。牙源性肿瘤的病理学分类很多,基于局部生物学行为的特点,WHO在2005年将原来的牙源性角化囊肿和牙源性钙化囊肿归列入牙源性肿瘤。牙源性肿瘤的临床表现多样,一般需要结合病理学检查确诊。手术处理是治疗牙源性肿瘤惟一有效的方法,但如何选择有效术式是临床医师需要慎重考虑的问题。本文就几种常见牙源性肿瘤的外科治疗作了简要概述。     

Non-neoplastic jaw cysts: a 30-year epidemiological study of 2150 cases in the Italian population

Non-neoplastic jaw cyst (NJC) is one of the most common lesions in oral cavity, but there are only few detailed and extended epidemiological data based on the 2017 WHO classification. The aim of this study was to perform an epidemiological analysis of all NJCs treated from 1990 to 2019 at the Marche Polytechnic University, and to compare these data with those published in the literature. This retrospective study considered 2060 patients treated from 1990 to 2019. The NJCs were classified according to the 2017 WHO classification, and the main clinicopathological variables were analysed (sex, age, diagnosis, site of onset, size, and recurrences). Of 2150 total lesions, there were 2095 primary cysts and 55 recurrences; men are more frequently affected than women (M/F ratio of 1.73:1). The mean age of occurrence was 46.6 years, with a peak of frequency in the fifth decade. The mandible was more frequently involved than the maxilla, with a mean size of 1.9 cm. Radicular cyst was the most frequently diagnosed cyst (56.6%), followed by dentigerous cyst (23.4%) and odontogenic keratocyst (12.9%). This is the first epidemiological study on NJCs in the Italian population according to 2017 WHO classification.     

牙源性囊肿和成釉细胞瘤体外骨吸收的实验研究

目的定量分析牙源性角化囊肿和成釉细胞瘤的体外骨吸收效应,探讨其颌骨吸收机制。方法收集25例牙源性囊肿[牙源性角化囊肿(OKC)14例、牙源性角化囊肿伴感染6例、含牙囊肿(DC)5例]和7例成釉细胞瘤的新鲜组织块行体外培养(24h),取其上清液与SD大鼠(新生5天)颅盖骨培养体系继续培养48h,以原子分光光度计法检测培养体系上清液中的Ca2+含量,从而判断不同牙源性病损在体外导致骨吸收作用的差异。同时采用放射免疫技术检测牙源性病损体外培养上清液中的骨吸收相关因子:白细胞介素6(IL6)、肿瘤坏死因子α(TNFα)、前列腺素E2(PGE2)、骨钙素(BGP)和降钙素(CT)等的含量。结果各组牙源性囊肿和肿瘤引起大鼠颅盖骨培养Ca2+析出的浓度显著高于空白组(P<0.01);OKC伴感染组Ca2+浓度显著高于OKC组和成釉细胞瘤组(P<0.05)。各组牙源性囊肿和成釉细胞瘤培养上清液中IL6、TNFα、PGE2和CT含量显著高于空白对照组(P<0.05);OKC组和OKC伴感染组IL6含量显著高于成釉细胞瘤组(P<0.05);OKC伴感染组CT含量显著高于OKC组和含牙囊肿组(P<0.05)。这些因子和Ca2+含量的相关性分析结果显示,IL6与钙值之间呈显著性正相关(P<0.01)。结论颌骨牙源性病损在体外可促进骨吸收,此作用可能与其产生的某些细胞因子有关。     

Keratocystic odontogenic tumor: a review

The odontogenic keratocyst is a very well known odontogenic cyst. There are many types of cysts of the jaws, but what makes the odontogenic keratocyst unusual are its characteristic histopathological and clinical features, including potentially aggressive behaviour, high recurrence rate, and an association with the nevoid basal cell carcinoma syndrome. The characteristic histologic feature i.e. the presence of parakeratin, is unique amongst all the different inflammatory and developmental cysts that occur in the jaws. Many treatment modalities have been advocated for its treatment, but none in particular has been regarded as the best treatment option. The 2005 WHO classification now uses the term ‘keratocystic odontogenic tumor’. We present a review of treatment modalities of the KCOT.     

Surgical management of dentigerous cyst and keratocystic odontogenic tumor in children: a conservative approach and 7-year follow-up

Dentigerous cyst (DC) is one of the most common odontogenic cysts of the jaws and rarely recurs. On the other hand, keratocystic odontogenic tumor (KCOT), formerly known as odontogenic keratocyst (OKC), is considered a benign unicystic or multicystic intraosseous neoplasm and one of the most aggressive odontogenic lesions presenting relatively high recurrence rate and a tendency to invade adjacent tissue. Two cases of these odontogenic lesions occurring in children are presented. They were very similar in clinical and radiographic characteristics, and both were treated by marsupialization. The treatment was chosen in order to preserve the associated permanent teeth with complementary orthodontic treatment to direct eruption of the associated permanent teeth. At 7-years of follow-up, none of the cases showed recurrence.     

Differential diagnosis between dentigerous cyst and benign tumor with an embedded tooth

It has been generally recognized that the radiological appearances of cysts and tumors related to an embedded tooth are similar. However, based on their clinical experience, Abrams et al. pointed out that there was a difference between the two lesions at the attachment point to the embedded tooth. To investigate this difference, we conducted a study employing the radiographs of patients who visited Nihon University Dental Hospital at Matsudo and were pathologically defined as having a cyst or tumor. Using radiographs of these patients, we investigated the attachment point to the embedded tooth, and expressed the results as the proportion of the attachment point to the embedded tooth root length. The study was carried out in 100 patients with cysts (87 dentigerous cysts and 13 odontogenic keratocysts), and 27 patients with benign tumors (24 ameloblastomas and three adenomatoid odontogenic tumors). Prior to treatment based on the numerical results, the distribution of the results was examined. Thus, we evaluated several methods of examining the distributions, and found the best method to be discriminant analysis. The results showed that the discriminated boundary value (from the cemento-enamel junction) was 0.38 for the embedded tooth root length. The cases showing a boundary value of less than 0.4 for the cemento-enamel junction were judged to be cysts, and those showing a value of 0.4 or more were judged to be benign tumors. The rate of misjudgement was 28% in the cyst group and 33.3% in the benign tumor group.     

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提要：从1971年至今,世界卫生组织已就牙源性肿瘤及相关病变的分类进行了3次编撰和修订,这一过程反映了几十年来人们通过大量的研究对这一类病变认识的不断深入。本文选取几种常见的牙源性病变,包括成釉细胞瘤、牙源性腺样瘤、牙源性角化囊性瘤及牙源性钙化囊性瘤等,回顾其组织学分类及命名的变迁,以期从另一个角度深化对这些病变的认识。     

Experimental odontogenic cysts induced by in vitro 4-nitroquinoline 1-oxide (4NQO) treatment of F344 rat incisor tooth germs

Miura Y, Ozaki HS, Li T-J, Uemura M, Kitano M: Experimental odontogenic cysts induced by in vitro 4-nitroquinoline 1-oxide (4NQO) treatment of F344 rat incisor tooth germs. J Oral Pathol Med 1998; 27: 53–8. © Munksgaard, 1998.
This study was designed to establish an experimental animal model for elucidating the early stages of odontogenic cysts and tumors. It involves the in vitro treatment of tooth germs with 4-nitroquinoline 1-oxide (4NQO) at the early bell stage and their subsequent transplantation into the kidney subcapsular space. While all tooth germ transplants of the control group not exposed to the carcinogen showed continued tooth development with no pathological lesions, 21 of 23 4NQO-treated tooth germs developed into similar appearing keratinized cysts with or without associated tooth structures. The remaining two transplants failed to develop cysts and formed only a tooth. The present experimental procedure was effective in inducing keratinized cystic lesions that exhibit some similarities to human odontogenic keratocysts or primordial cysts.