开窗减压术结合牵引矫治方法治疗替牙期含牙囊肿的疗效观察

目的观察开窗减压术式结合牵引矫治方法治疗替牙期含牙囊肿的治疗效果。方法收集南京医科大学附属口腔医院2007~2012年收治的12例替牙期颌骨含牙囊肿病例,采取开窗减压手术治疗保留囊肿涉及的恒牙、佩戴塞制器保持引流口通畅并进行间隙保持,结合后期的固定矫治器正畸牵引治疗,术后随访2~3年观察颌骨内囊肿骨组织愈合及恒牙萌出情况。结果本组12例含牙囊肿患儿经开窗减压术结合牵引矫治方法治疗后12~15个月后,所有患儿囊肿包含的恒牙全部牵引出龈且经治疗后牙齿排列整齐,面部形态恢复正常,影像学检查显示囊腔低密度影消失,术后随访2年以上均未见囊肿复发。结论对儿童替牙期颌骨含牙囊肿采取开窗减压术结合正畸治疗是一种能够最大程度保留病变区恒牙及颌骨组织的有效方法。     

31例儿童及青少年期含牙囊肿保守治疗临床观察

目的 通过对31例儿童及青少年含牙囊肿的诊治,总结其发病特点及治疗经验.方法 收集北京儿童医院2008 ～ 2012年31例颌骨含牙囊肿病例,回顾性分析囊肿的部位、原因,根据囊肿部位及大小,结合恒牙胚的位置采取拔除病灶牙的一次性开窗治疗或进行开窗减压长期冲洗治疗,并对部分病例采用保留恒牙胚的囊肿刮除手术治疗,观察治疗结果.结果 儿童及青少年颌骨囊肿好发牙位为下颌前磨牙区,其次是上颌尖牙区及上颌中切牙区.前牙区发病多与乳牙龋坏及外伤有关,后牙区发病多与乳牙龋坏有关.通过以上保守治疗可以最大程度保留囊腔内继承恒牙,部分位置异常的牙齿需要进一步辅助正畸治疗.结论 儿童及青少年含牙囊肿,根据囊肿的大小和部位选择适合的保留恒牙胚的治疗方法,可以达到较好的效果,部分病例需要进一步正畸治疗.     

替牙期儿童下颌含牙囊肿开窗减压术的临床观察

目的:探讨开窗减压术治疗替牙期儿童下颌含牙囊肿的效果。方法 :本文收集就诊于上海交通大学附属第九人民医院口腔颌面外科的,替牙期下颌含牙囊肿患儿经开窗减压术后牙萌出的资料,分为病变侧及健侧,进行自身对照。结果:32例患儿平均年龄为(9.4±0.8)岁。经过开窗减压术后,所有囊肿累及的恒牙均萌出至正常位置。随访全景片显示所有囊肿消失,新生骨形成。病变侧恒牙萌出时间小于自身对照组。结论:本文研究结果表明,开窗减压术可成功治愈替牙期儿童下颌含牙囊肿,且囊肿累及的恒牙可自然萌出。     

大型颌骨囊肿伴远端埋伏牙的外科－正畸联合治疗

目的：总结大型颌骨囊肿伴埋伏牙病例进行外科－正畸联合治疗的临床效果。方法：16例大型颌骨囊肿伴远端埋伏牙病例应用开窗减压手术治疗，术中保留累及恒牙，术后配戴囊肿塞治器。术后第1、3、6个月，之后每半年随访，拍摄全景片，观察囊腔减小程度及新骨形成情况，择期正畸牵引或外科辅助正畸牵引埋伏牙复位。结果：16例患者开窗减压术后随访1~5．5年，平均随访3年；囊腔均逐渐减小直至消失，愈合良好，因囊肿而远端异位的牙齿均可自行复位至接近正常位置。替牙完成后配合正畸牵引或外科辅助正畸牵引，正畸疗程平均2年。结论：口腔颌面外科－正畸联合治疗为颌骨囊肿伴埋伏牙的治疗提供了新的方法。     

囊肿塞子在颌骨囊肿开窗减压术中的应用

目的 探讨囊肿塞子在颌骨囊肿开窗减压术中的应用价值。 方法 选取2008年至今巨大颌骨囊肿和替牙期囊肿患者共122例,行开窗减压术后制作125件囊肿塞子（1例多发囊肿）,观察效果。 结果 本组病例中100例患者囊腔在1~2年内闭合,包含23例9~12岁儿童,22例患者遗留一小囊腔,需二次手术,随访2年无一例复发。下颌愈合时间较上颌愈合时间短,所有混合牙列期患者恒牙均正常萌出,膨出的面型恢复正常。 结论 颌骨囊肿开窗减压术后佩戴囊肿塞子可以有效地阻止食物进入囊腔,引流出囊液。     

替牙(牙合)期下颌骨囊性病变的治疗

目的 探讨替牙验期下颌骨囊性病变的治疗方法.方法 对7例替牙验期下颌骨囊性病变(4例单囊型成釉细胞瘤,3例含牙囊肿一期行开窗减压术,二期行保留颌骨的刮治术,术后随访6～18个月,评价治疗效果.结果 7例替牙(牙合)期下颌骨囊性病变术后缺损得到明显修复,相关牙齿得到保留且有不同程度萌出,保存了下颌骨的连续性及咬合功能.结论 采用一期开窗减压术结合二期行保留颌骨的刮治术治疗替牙(牙合)期下颌骨囊性病变能有效保存下颌骨连续性,避免由于早期刮治导致相关牙齿的缺失以及下颌骨连续性的中断.     

替牙期下颌骨囊性病变的治疗

目的探讨替牙期下颌骨囊性病变的治疗方法。方法对7例替牙期下颌骨囊性病变(4例单囊型成釉细胞瘤,3例含牙囊肿)一期行开窗减压术,二期行保留颌骨的刮治术,术后随访6~18个月,评价治疗效果。结果7例替牙期下颌骨囊性病变术后缺损得到明显修复,相关牙齿得到保留且有不同程度萌出,保存了下颌骨的连续性及咬合功能。结论采用一期开窗减压术结合二期行保留颌骨的刮治术治疗替牙期下颌骨囊性病变能有效保存下颌骨连续性,避免由于早期刮治导致相关牙齿的缺失以及下颌骨连续性的中断。     

开窗减压术合并改良间隙保持器治疗儿童大型含牙囊肿

目的:评价开窗减压术及改良间隙保持器对儿童大型含牙囊肿的治疗效果。方法:对11例大型含牙囊肿进行开窗减压术,囊液持续引流,;囊腔内碘仿纱条填塞,1周后佩改良间隙保持。随访6~24个月。结果:11例囊肿基本消失,新骨形成。1例患者需额外的正畸治疗。囊腔内的牙全部萌出或明显萌出趋势。所有患者囊肿未有复发。结论:开窗减压术合并改良间隙保持器是一种安全、可靠、效果确实的治疗儿童大型含牙囊肿的方法。不仅恢复患者的美观及功能,还能帮助儿童因失牙引起的心理问题。     

儿童混合牙列期牙源性颌骨囊肿开窗减压术的疗效评价

目的观察开窗减压术治疗儿童混合牙列期牙源性颌骨囊肿的疗效及最佳评价时点。方法28例4～12岁的儿童颌骨囊肿病例,行囊肿上方乳牙拔除或颊侧翻瓣开窗术,同期冲洗引流管植入固定,每日行抗生素溶液囊腔冲洗。于术后1,3,6个月复诊,行曲面断层片观察对比疗效。参照Nakamura袋形术治疗颌骨囊肿的疗效评价标准对各时间点的治疗效果进行观察。结果术后1、3和6个月囊肿长径进行性缩小。Fisher＇s确切概率法疗效评价结果为,术后1和3个月有效率差异有统计学意义;而术后3个月和6个月有效率差异无统计学意义。术后3个月观察,19例（67．86％）颌骨囊肿行开窗减压术后疗效评价为优,8例（28．57％）评价为良,1例（3．57％）评价为疗效差,总有效率为96．43％,与1年后的最终治愈率相同。骨质破坏区面积有较大程度的缩小甚至基本消失,囊腔周围新骨生成活跃,挤压移位的恒牙胚基本回位并能正常萌出,患儿能够很好配合和耐受。结论儿童混合牙列期颌骨囊肿开窗减压术,很好地起到了导萌、保留恒牙、去除囊肿的效果,是一项适合推广的技术方法。术后3个月是疗效评价最佳时点。     

囊肿塞子在颌骨囊肿治疗中的临床应用

选取颌骨囊肿开窗减压治疗术后患者39例,戴用囊肿塞子。所有患者均在1～2年内囊腔愈合,其中3例替牙期患者恒牙顺利萌出。囊肿塞子在颌骨囊肿治疗中起到了持续开窗引流作用,防止开窗口提前愈合减轻了囊腔食物残渣污染;患者戴用方便,治疗依从性好。     

输液管在儿童替牙期含牙囊肿开窗术中的应用

目的:探讨输液管在儿童替牙期含牙囊肿开窗引流术中的作用。方法 :分析2003-12—2011-12我院口腔颌面外科收治的经病理证实为含牙囊肿的替牙期儿童病例22例,平均年龄11岁,所有病例术前均拍摄曲面断层片和局部小牙片,囊肿直径3～5 cm,其中含多生牙9例。术中拔除部分乳牙及多生牙,于拔牙创处开窗,切取部分囊壁,拔牙创口置直径0.4 cm、长约1.0～1.5 cm输液管,并固定于牙龈或邻近牙齿。每日冲洗,术后3个月、6个月、1年随访,同时拍摄曲面断层片检查。结果:所有病例在开窗术后早期局部轻度红肿疼痛,3个月后囊肿明显减小,6～7个月时骨质膨隆消失,10～11个月时X线检查囊肿低密度影像消失。13例恒牙自行正位萌出,4例出现尖牙与侧切牙错位萌出,5例恒牙未自行萌出。在开窗引流期间,无1例患者伤口感染,均引流通畅。结论:输液管在儿童替牙期含牙囊肿开窗引流术中,具有操作简单、患者术后依从性高、创伤痛苦小、复诊次数少、引流通畅、成本低廉、易于推广等特点,是治疗儿童替牙期含牙囊肿的较理想方法。     

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.     

Conservative management of a large dentigerous cyst in a 6-year-old girl: a case report

Dentigerous cysts are benign odontogenic cysts that are associated with the crowns of permanent teeth. They are usually characterized as unilocular radiolucent lesions and are rarely seen during childhood. The purpose of this article was to report the case of a 6-year-old girl with a dentigerous cyst associated with the tooth buds of premolars. The therapeutic approach included extraction of the primary molar involved and marsupialization of the lesion. After 21 months of follow-up, spontaneous eruptions of the impacted premolars were noticed. In conclusion, marsupialization might be the first treatment option for conservative management of dentigerous cysts in children.     

含牙囊肿囊内埋伏牙的正畸治疗

目的:探讨及评估含牙囊肿囊内埋伏牙的正畸治疗方法及效果。方法:对9颗含牙囊肿内埋伏牙以固定矫治器结合外科开窗、囊肿刮除,正畸牵引导萌进行治疗。结果:所有病例X线片示囊腔消失,腔内骨组织再生,病变的囊性组织为正常骨组织所代替;埋伏牙被引导至正常的位置,牙根发育正常;牙列排齐、后牙尖窝关系良好和覆盖覆牙合正常。完成时间为14～36月,平均为21.25月。结论:外科开窗、囊肿刮除结合正畸牵引治疗含牙囊肿可消除囊腔,促进正常牙槽骨的再生和有助囊内埋伏阻生牙的萌出排齐。     

Dentigerous cysts in primary dentition: report of 2 cases

Dentigerous cysts are benign odontogenic cysts associated with the crowns of permanent teeth. They are usually single in occurrence and located in the mandible. The purpose of this case report was to describe the management of 2 dentigerous cysts in children. The treatments instituted were the extraction of the deciduous tooth involved followed by marsupialization in the first case and enucleation in the second one. Both treatments allowed rapid healing of the lesion and eruption of the permanent teeth without the need for orthodontic treatment.     

Conservative management of a dentigerous cyst secondary to primary tooth trauma

Abstract – Pulp necrosis is a commonly observed sequela in traumatized primary teeth and is one of the possible etiologic factors for the development of dentigerous teeth. This article reports the case of a dentigerous cyst associated with the germ of a permanent maxillary central incisor that developed secondary to trauma to the predecessor primary incisor. The therapeutic approach included endodontic treatment of the primary tooth and marsupialization of the lesion. After 36 months of follow up, the permanent incisor presented with normal physiologic conditions, absence of dental anomalies and erupted in its correct position in the oral cavity. In conclusion, with proper case selection, marsupialization might be a good treatment option for conservative management of dentigerous cysts.     

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.     

Marsupialization: a conservative approach for treating dentigerous cyst in children in the mixed dentition

Dentigerous cysts are usually encountered in the practice of pediatric dentistry. The treatment modalities range from marsupialization to enucleation of the lesion and are based on the involvement of the lesion with the adjacent structures. However, loss of a permanent tooth in the management of a dentigerous cyst can be devastating to a child who has already a congenitally missing tooth. The first case describes the technique of marsupialization in which we extracted the grossly carious deciduous 1st molar and created a window through the extracted socket to decompress the lesion. In this case the 2nd premolars were congenitally missing on both sides of the mandible for which we had not gone for enucleation of the dentigerous cyst along with the developing 1st premolar. The second case is a developmental type of a big dentigerous cyst where marsupialization was followed by enucleation of the cystic lining but without removal of the affected tooth. Both the teeth erupted in the oral cavity.     

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。