55例牙源性颌骨囊肿治疗体会

目的：总结牙源性颌骨囊肿的诊断和治疗方法。方法：回顾分析55例经病理诊断为牙源性颌骨囊肿病例的临床资料和手术方法。结果：55例牙源性颌骨囊肿中28例经囊肿刮除术术后无复发;25例袋形术病例中有11例在局麻下行二期刮除术后痊愈;2例行颌骨节段切除术和同期骨移植术修复,无复发,无排异反应。结论：牙源性颌骨囊肿早期确诊非常重要,正确的手术方法可提高临床疗效和有效保存患者颌骨的生理功能。     

颌骨牙源性囊肿袋形术/减压术引流装置的设计与临床应用

颌骨牙源性囊肿是一组来源于与牙发生相关组织的病变，上皮衬里的囊腔包含液体或半流体。由于囊腔内的压力、骨吸收因子释放及上皮增生引起囊肿不断增大，导致颌骨膨隆、牙松动移位，面部畸形及咬合功能障碍。牙源性囊肿的袋形术/减压术是一种简单易行而有效的保守性治疗方法。成功的治疗需要术后采用不同引流装置保持囊肿引流。较大的囊肿常在术后配戴囊肿塞或阻塞器，而较小的病变则通过减压管保守引流。大多数病例是在袋形术/减压术后囊肿缩小时二期行囊肿刮除术，可减少邻近结构的损伤或手术并发症，仅少数病例中袋形术作为惟一的治疗方式。文章简要介绍了袋形术/减压术的相关治疗机制以及多种引流装置的设计与临床应用。     

颌骨牙源性囊肿袋形术/减压术引流装置的设计与临床应用

 颌骨牙源性囊肿是一组来源于与牙发生相关组织的病变，上皮衬里的囊腔包含液体或半流体。由于囊腔内的压力、骨吸收因子释放及上皮增生引起囊肿不断增大，导致颌骨膨隆、牙松动移位，面部畸形及咬合功能障碍。牙源性囊肿的袋形术/减压术是一种简单易行而有效的保守性治疗方法。成功的治疗需要术后采用不同引流装置保持囊肿引流。较大的囊肿常在术后配戴囊肿塞或阻塞器，而较小的病变则通过减压管保守引流。大多数病例是在袋形术/减压术后囊肿缩小时二期行囊肿刮除术，可减少邻近结构的损伤或手术并发症，仅少数病例中袋形术作为惟一的治疗方式。文章简要介绍了袋形术/减压术的相关治疗机制以及多种引流装置的设计与临床应用。     

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。     

牙源性角化囊肿袋形术后的骨形成与改建

目的：本研究的目的是评价颌骨牙源性角化囊肿袋形术后骨形成的特点。方法：65例牙源性角化囊肿患者采用袋形术治疗。术后第3和第6个月分别进行临床、x线检查。病变范围广泛或曲面体层片上显示骨皮质破坏的患者补充CT检查。评估囊肿大小、皮质板穿通、下颌管的连续性、囊内牙移位及患区骨密度变化等。结果：在术后3个月,皮质板破坏区的骨连续性重新建立,下颌管的连续性部分恢复,变形的下颌骨呈现改建。囊内含牙随着囊肿的缩小而发生位移或部分萌出。曲面体层片显示,囊肿区骨密度值不断增加,术后3个月46．07％,术后6月达到64．69％。结论：牙源性角化囊肿袋形术后头3个月患区骨再生较快,一部分解剖形态恢复,此后新骨形成相对较慢,骨改建仍在进行。     

颌骨囊性病受累牙处理的现代策略

颌骨囊肿及部分囊性肿瘤持续生长,可造成面部畸形,牙萌出障碍、松动移位,咬合关系紊乱等。牙髓活力丧失的根尖周囊肿的病源牙,常采用根管治疗术或囊肿刮除术中拔除。而牙源性发育性囊肿或囊性肿瘤累及的健康牙,尤其是牙根突入病变内时如何处理,保留或是术中拔除,何时根管治疗,是否行根尖切除等,尚无一致的意见。对于牙源性发育性囊肿内的阻生牙,根据患者年齡、牙的发育阶段、深度与角度,以及病变部位与大小等,有多种不同处理方式,如袋形术、刮除术中牙拔除或截冠术等。本文复习近年的文献,并结合作者的经验,介绍颌骨囊性病变受累牙处理的现代理念与方法。     

53例角化囊性瘤治疗方法的探讨

目的：探讨牙源性角化囊性瘤的治疗方法。方法：分析比较53例角化囊性瘤经囊肿刮除术、开窗减压术2种不同的手术方法治疗的临床效果。结果：53例角化囊性瘤中15例采取刮除术,38例采取开窗减压术,其中13例采用二期行刮除术治愈;随访期内无复发病例。结论：刮除术和开窗减压术均能有效治疗牙源性角化囊性瘤。牙源性角化囊性瘤应根据患者的个体差异制定个体化的治疗方案。     

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。     

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。     

152例牙源性颌骨囊肿治疗体会

目的研究牙源性颌骨囊肿的治疗方法。方法回顾分析比较 152例牙源性颌骨囊肿经囊肿刮治术、开窗术及颌骨切除术3种不同的手术方法。结果 152例牙源性颌骨囊肿中98例经囊肿刮治术无1例复发;开窗术50例中有22例需二期行刮治术治愈;4例牙源性颌骨囊肿行颌骨切除术及同期髂骨移植修复 术,无复发及排异反应。结论牙源性颌骨囊肿早期确诊非常重要,根据病患的个体差异制定个体化的治疗方案。?     

袋形术或减压术治疗颌骨囊性病变

颌骨囊肿的袋形术或减压术最早由Partsch（1892）在德文文献中介绍,因此亦称Partsch Ⅰ式手术。在英文文献中,袋形术（marsupialization）和减压术（decompression）2种术语有时未能严格区分,但其内涵有所不同。袋形术是指采用手术方法去除一部分囊壁,并将其创缘与口腔黏膜缝合形成袋口状,使得囊腔与口腔相通。     

Fourteen-year study of the management of the odontogenic keratocyst. Are adjunctive therapies all they are cut out to be?

Odontogenic keratocysts (OKC) are benign, developmental, locally-aggressive odontogenic cystic lesions with a high risk of recurrence. As such, the most effective treatment modalities remain controversial. The mainstay of treatment remains enucleation with or without decompression. The use of adjunctive therapies is widely reported. Our aim was to review our experience of OKCs and therefore identify the treatment modality, if there is any single one, with the lowest rate of recurrence. We also aimed to identify any common themes linking those patients experiencing cystic recurrence. Data were collected on 50 patients treated at UHCW NHS Trust over a 14-year period (2005-2018) via an anonymised database. Surgical pathways were analysed, including details of the location of the cysts and the use of adjunctive therapies, namely; mechanical debridement, cryotherapy, and the use of Carnoy’s solution. Fifty-six keratocysts, both primary (91%, n = 51) and recurrent (9%, n = 5) were included. A total of 6% of patients had a pre-existing diagnosis of Gorlin-Goltz Syndrome (n = 3). Enucleation was performed in an approximately 3:1 ratio to decompression with secondary enucleation (n = 41:15). Twenty-seven percent of patients had adjunctive therapies (n = 15). There was a 12% recurrence rate (n = 6) found only within the group of primary cysts that had been enucleated only. Notably, there were no recurrences in those cysts that had undergone adjunctive therapy. None of the cysts that underwent initial decompression or marsupialisation recurred. Following surgical intervention, no tertiary recurrent cysts were detected postoperatively. This study demonstrated the advantage of establishing a correct diagnosis prior to definitive treatment. Initial decompression in selected patients followed by enucleation, along with adjunctive therapies showed a benefit in reducing recurrences. However, in the absence of high-quality evidence for the most effective management of odontogenic keratocysts, finding a common approach will remain controversial.     

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.     

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.     

袋形术与正畸治疗促进含牙囊肿内阻生牙萌出

含牙囊肿是口腔内常见的颌骨囊性病变之一，通常伴有阻生牙。刮除术虽能根除病变，但易造成牙列缺损、神经损伤、邻牙损伤或牙髓活力丧失等。近年来临床上常用的袋形术，可减少邻近结构的创伤及提高囊内阻生牙的存留率，对于位置深或无法自行萌出的阻生牙配合正畸牵引可取得满意的效果。文章简要介绍含牙囊肿的形成、袋形术的适应证以及囊肿内阻生牙的正畸牵引等临床问题。     

Calretinin expression in odontogenic cysts

Calretinin is a calcium-binding protein with a possible role as a calcium buffer, calcium-sensor, or regulator of apoptosis. Calretinin is expressed in neural tissue, is a specific marker of mesothelial cells, and has been demonstrated in the odontogenic epithelium during odontogenesis in rat molar tooth germs. Moreover, it has been found to be expressed in a high proportion of solid, unicystic, and multicystic ameloblastomas, whereas, on the contrary, no positive staining has been found in odontogenic keratocysts, residual cysts, and dentigerous cysts. The purpose of this study was to evaluate calretinin expression in radicular cysts, follicular cysts, orthokeratinized keratocysts, and parakeratinized keratocysts. A total of 70 odontogenic cysts, 24 radicular cysts, 24 follicular cysts, and 22 odontogenic keratocysts (10 orthokeratinized keratocysts, 12 parakeratinized keratocysts) were evaluated. All the radicular cysts, follicular cysts, and orthokeratinized keratocysts were negative. However in 8 of 12 parakeratinized keratocysts, there was a positivity to calretinin in the parabasal-intermediate layers of the cyst epithelium. This positivity to calretinin in the parabasal layers in parakeratinized keratocysts, similar to that found for other markers like PCNA and p53, could point to an abnormal control of the cell cycle and could help to explain the differences in the clinical and pathologic behavior of odontogenic keratocysts, in particular the differences found between orthokeratinized keratocysts and parakeratinized keratocysts.     

袋形术与正畸治疗促进含牙囊肿内阻生牙萌出

 含牙囊肿是口腔内常见的颌骨囊性病变之一，通常伴有阻生牙。刮除术虽能根除病变，但易造成牙列缺损、神经损伤、邻牙损伤或牙髓活力丧失等。近年来临床上常用的袋形术，可减少邻近结构的创伤及提高囊内阻生牙的存留率，对于位置深或无法自行萌出的阻生牙配合正畸牵引可取得满意的效果。文章简要介绍含牙囊肿的形成、袋形术的适应证以及囊肿内阻生牙的正畸牵引等临床问题。     

Treatment of odontogenic keratocysts: a follow-up of 255 Chinese patients

OBJECTIVE: The purpose of this study was to report our experience in the surgical treatment of 484 Chinese patients with follow-up in 255 cases. METHODS: A retrospective analysis was conducted of all odontogenic keratocysts that were surgically treated and histopathologically diagnosed between 1962 and 1998. The odontogenic keratocysts were surgically treated with enucleation, marsupialization followed by secondary enucleation, and resection with or without continuity defects. The recurrence rate was evaluated for the patients followed more than 3 years. RESULTS: Of a total of 489 odontogenic keratocysts, 327 (66.87%) were found in the mandible and 162 (33.13%) in the maxilla. Follow-up data were obtained in 255 patients. Recurrence was found in 31 cases (15.27%) in 203 patients treated with enucleation after an observation period of 3 to 29 years. Twenty-nine recurrences (17.79%) were found in 163 patients treated with enucleation alone, two recurrences (6.70%) were seen in 29 patients who received Carnoy's solution fixation of the cyst wall before enucleation, and no recurrence was found in 11 cases treated with marsupialization in combination with secondary enucleation. No recurrence was seen in 52 patients treated with resection. CONCLUSION: Odontogenic keratocysts treated with enucleation alone have a higher recurrence rate. Enucleation with adjunctive treatment can decrease recurrence rate. Radical excision has no recurrence but does have the highest morbidity rate and should be reserved for multiple recurrent cysts after conservative means.     

Conservative treatment of dentigerous cyst associated with primary teeth

Dentigerous cyst is the most common odontogenic cyst. It is characterized by a unilocular radiolucent lesion that encloses permanent tooth buds or, under certain circumstances, displaced tooth buds. Buccal bony expansion is the most common clinical feature. Several treatment modalities have been mentioned in the literature for management of dentigerous cysts. The purpose of this article was to report an extensive right mandibular dentigerous cyst on a 10-year-old boy. Marsupialization was chosen to preserve the permanent tooth bud and a denturelike obturator was then provided for space maintenance and masticatory function. Long-term follow-up revealed good healing of the bony lesion with converted tooth eruption.     

The lateral periodontal cyst. A report of 37 cases

The lateral periodontal cyst is a developmental cyst of odontogenic origin which is located along the lateral aspect of a tooth root. Thirty-seven previously unreported lateral periodontal cysts ( LPCs ) are presented. Clinical, roentgenographic and histologic features of the LPC are reviewed. Further, the importance of distinguishing the developmental LPC from laterally positioned inflammatory cysts of pulpal or periodontal disease origin and laterally occurring odontogenic keratocysts is stressed.