复发性牙源性角化囊肿增长速率的临床评价

目的:评价和分析复发性牙源性角化囊肿的增长速率及其早期影像学特点。方法:选择剜除术后X线显示复发并随访6～36个月的3例下颌骨牙源性角化囊肿患者,在X线片上测量比较囊肿最大直径,计算其年均增长速率,并评估其早期影像学特征。结果:8个复发性囊肿增长速率为0.67～22.0mm/a,平均为4.79mm/a。术后短期内的复发病变生长较快,且病变一般无明显硬化缘。此外,早期发现的多个独立的小的复发病变可逐渐增长,融合成多房性囊肿。结论:复发性牙源性角化囊肿的增长速率与其复发时间密切相关,多个独立的小囊肿在迅速增大后可形成多房性病变。     

牙源性角化囊肿感染及与术后并发症、复发间关系初探

84例牙源性角化囊肿 ,通过临床 X线 ,术后组织病理观察 ,对其感染 ,感染与术后并发症 ,与复发间关系进行初探。结果显示 :角化囊肿感染率高达 6 5 .5 % ,临床颌骨囊肿伴感染时 ,应考虑到角化囊肿可能性大。术前囊肿伴感染者术后并发症的发生远高于术前无感染者 ,两组间差异显著 (P<0 .0 5 )。故角化囊肿应注意给予抗感染治疗。但术前伴感染者与非感染者相比 ,复发率无明显差异。显示牙源性角化囊肿的炎性感染与复发间的内在联系 ,是值得进一步探讨的课题     

牙源性角化囊肿复发原因分析

本文报道了８４例牙源性角化囊肿（含１４例复发）临床、Ｘ线、病理及超微结构观察，并对其复发原因进行分析。结果表明，（１）Ｘ线呈多房型、组织病理学见炎症细胞浸润较多存在于复发ＯＫＣ，但无统计学意义；（２）超微结构观察，上皮衬里细胞核变化大，多聚核糖体增多，线粒体形态改变提示复发ＯＫＣ上皮生长活跃；（３）手术式同复发有关，单纯性囊肿剜出术较之于病灶扩大切除更易于术后复发。     

内窥镜辅助下精准微创刮治术治疗下颌骨大型牙源性角化囊肿效果观察

目的:观察下颌骨大型单房或多房牙源性角化囊肿在内窥镜辅助下行精准微创刮治术后的临床效果。方法:17例下颌骨大型单房或多房的牙源性角化囊肿患者，在内窥镜辅助下口内切口行微创刮治。术后定期随访，观察囊腔和颜面部变化，分析治疗效果。结果:17例患者术后随访14～36个月，无囊腔范围增大，无局部感染发生。其中完全恢复14例，稳定无进展3例，总有效率达100%。17例患者，均未行二期手术，未见囊肿复发。结论:内窥镜辅助下精准微创刮治术治疗下颌骨大型牙源性角化囊肿具有可行性和优越性。     

颌骨囊性病损X线研究——附472例X线影像分析

本文对472例经组织病理学证实的颌骨囊性病损,接其病变生长方式、好发部位与牙齿关系以及对颌骨改变等 X 线表现进行分析和统计,找出了牙源性角化囊肿和造釉细胞瘤的各自 X 线特点。     

36例与阻生牙相关的牙源性角化囊肿的临床影像学特点分析

目的:分析与阻生牙有关的牙源性角化囊肿的临床和影像学特点。方法:对235例牙源性角化囊肿中36例与阻生牙有关的临床、影像学资料进行回顾分析。结果:在与阻生牙有关的牙源性角化囊肿病例中,男女比例为1.77∶1,下颌磨牙-下颌支部26例,占72.22%;19例（52.8%）在20~30岁就诊。单房型27例（75%）,多房型9例（25%）;牙冠位于囊内13例（36.11%）,整个牙位于病变内15例（41.67%),而阻生牙位于病变一侧8例（22.22%）。结论:与阻生牙有关的牙源性角化囊肿的一个主要影像学特点是,整个牙被病变包绕或位于囊肿一侧,而表现为冠周密度减低影像者较少。     

牙源性钙化囊肿

牙源性钙化囊肿是一种特殊的牙源性病损，发生率较低，临床诊断较难，确诊需组织病理学检查。本文报道了我院１９８２～１９９６年间收治的２３例牙源性钙化囊肿的临床资料，就其临床、Ｘ线、病理的表现特点及治疗进行分析讨论，并提出了临床治疗原则，认为术式的选择与术后复发有密切的关系。     

减压术治疗下颌骨大型牙源性角化囊肿的临床研究

目的：评价减压术治疗下颌骨大型牙源性角化囊肿的疗效。方法：回顾1999年10月至2004年10月61例经减压术治疗的下颌骨大型角化囊肿病例．随访6个月～5a，进行临床、影像学及病理学检查，在全景片上测量减压术后病灶的长径变化，评价临床疗效．随访观察复发情况：采用SAS6．12统计软件包进行X^2检验，计算Fisher确切慨率。结果：临床及影像学检查显示，囊肿周同骨质再生改建，囊腔逐渐缩小．被推移的下牙槽神经血管束恢复至正常位置，倾斜移位的牙长轴逐渐纠正减乐术后引流期维持6～23个月，中位时间14个月。减压术治疗颌骨大型角化囊肿的有效率为91．8％，单房型角化囊肿的疗效优于多房型，不同年龄组间的有效率在统计学上无显著差异。本组资料随访期间未发现复发。结论：减乐术是治疗下颌骨大型牙源性角化囊肿的有效方法。     

牙源性粘液瘤26例分析

目的：探讨牙源性粘液瘤的临床、X线、病理特征及治疗。方法：对26例经病理确诊的牙源性粘液瘤进行分析总结。结果：本组病例男11例,女15例;平均年龄25．9岁;在X线片上多表现为单房或多房的透光阴影;镜下可见大量蓝色粘液样组织及排列疏松的瘤细胞;4例刮治术后复发。结论：牙源性粘液瘤临床症状不典型,影像学表现复杂多样化,常需病理检查确诊。因其具有局部浸润性,手术切除不彻底易复发。     

保守治疗牙源性角化囊肿的初步探讨

目的:探讨保守治疗牙源性角化囊肿的可行性和临床意义。方法:对我院近几年收治的囊肿较大、多发或不愿作根治术的12名患者,行彻底刮治术加开窗术的保守治疗,术后佩带塞治器,观察其疗效和复发率。结果:术后0.5～1年X线显示9例原病变区有大量新生骨质沉积,3例无明显疗效,有效率为75%,随访1～3年,复发4例,复发率为33.3%。结论:牙源性角化囊肿保守治疗有一定临床疗效,但尚需降低复发率。     

Odontogenic keratocysts: a clinical and histologic comparison of the parakeratin and orthokeratin variants.

Four hundred forty-nine cases of odontogenic keratocyst (OKC) were separated into three histologic categories: parakeratinized, orthokeratinized, or a combination of the two types. Demographic and clinical data, such as anatomic location and recurrence, were obtained from the biopsy forms. Results showed that 86.2% of the 449 cases were parakeratinized, 12.2% were orthokeratinized, and 1.6% had features of both orthokeratin and parakeratin. There were no statistically significant differences between orthokeratinized and parakeratinized OKCs when age, race, sex, presenting symptoms, and the clinical impression were compared. The orthokeratinized OKC was more often associated with an impacted tooth (75.7%), as compared with 47.8% for the parakeratinized OKC (P = .001). Parakeratinized OKCs recurred in at least 42.6% of the cases, compared with only 2.2% for orthokeratinized OKCs. This study emphasizes the importance of distinguishing between the parakeratin and orthokeratin variants of OKC. In addition, data are presented that show the need for longer follow-up than previously documented.     

正角化牙源性囊肿的临床病理及免疫组化研究

目的：探讨一组正角化牙源性囊肿（orthokeratinized odontogenic cyst,OOC)的临床病理及免疫组化特点。方法：以OOC的名称报告20例，观察其组织学和免疫组化特点，并与牙源性角化囊肿（odontogenic keratocyst,OKC)病变进行比较。结果：本组病例约占同期所有OKC的9．9％（20／202），其中男性14例，女性6例，就诊平均年龄39．1％；随访资料显示：15例患者行囊肿刮治后无复发；组织学和免疫组化比较发现：OOC和OKC之间差异有显著性，OOC上皮不表现OKC上皮的形态分化特点，细胞增殖活性较低。结论：OOC可能代表一组有别于牙源性角化囊肿的颌骨病损。     

Histopathological features that predict the recurrence of odontogenic keratocysts

J Oral Pathol Med (2012) 41 : 408–414 Background: Odontogenic keratocysts (OKCs) constitute between 1.8% and 21.5% of odontogenic cysts and are associated with higher propensity to recur than other odontogenic cysts following surgical removal. Previous studies have been performed to identify clinico‐pathological predictive factors in relation to such behaviour. The relationship between the presence of hyalinisation and recurrence of the OKC has not been explored. Methods: A total of 110 OKCs were selected, comprising 53 non‐recurrent cases, 50 cases known to subsequently recur and seven syndromic cases. Cases were examined blind, and histological assessment of the epithelial lining, connective tissue capsule and cyst lumen was made. Statistical analysis was completed using Pearson Chi‐square, Fisher’s exact test and logistic regression analysis. Results: Subepithelial hyalinisation of the underlying connective tissue capsule (P = 0.006) was significantly more common in OKC that recurred. Recurring cysts demonstrating hyalinisation were seen in a younger age group (mean = 40.8 years) than the non‐recurrent cysts (mean = 56.4 years). In addition, subepithelial splitting (P = 0.015) and the position of mitotic figures (P = 0.033) were more common in recurring cysts. Conclusion: In this case series, several differences were found in relation to histological features of recurring and non‐recurring OKCs. There are many factors responsible for the high recurrence rate of OKCs, and the presence of subepithelial hyalinisation may be used as an additional histopathological feature to predict a greater tendency for recurrence.     

下颌骨成釉细胞瘤复发原因的临床研究

目的：探讨下颌骨成釉细胞瘤复发的原冈。方法：分析21例下颌骨成釉细胞瘤复发患者的病理、X线片、手术方式与肿瘤复发的关系。结果：下颌骨成釉细胞瘤复发平均年龄38．7岁，平均复发时间术后54．6个月。复发部位多局限于下颌骨，仅有1例软组织转移一病理类型多为滤泡型，占80.95％。X线表现多房型占71．43％，单房型占23．81％。结论：手术方式是下颌骨成釉细胞瘤复发与否的决定因素，X线观察和病理诊断可以为决定手术方式提供参照，但存在很大局限性。术后5年内患者定期复查X线片对下颌骨成釉细胞瘤复发的及时发现非常重要。     

Recurrence of keratocysts. A long-term follow-up study

The aim of the study was to investigate the recurrence rate of keratocysts based on a material with a follow-up of at least 5 years, and to evaluate the relationship between different features of these cysts and their recurrence. It was found that of 75 keratocysts with follow-up times ranging from 5 to 17 years (mean 8.3), 32 (43%) recurred. The cumulative recurrence rate of the 67 annually examined cysts increased from 3% after the 1st year following the operation to 37% after the 3rd year. Thereafter, no new recurrences were noted. Recurrence of keratocysts in patients with basal cell nevus syndrome occurred more frequently than that of patients without the syndrome. Keratocysts enucleated in one piece recurred significantly less often than cysts enucleated in several pieces. The recurrence rate of keratocysts with a clinically observable infection, with fistula or with a perforated bony wall was higher than that of keratocysts without these features. Recurrence was also found more frequently in cysts with multilocular radiographic appearance than in unilocular cysts. The size or the location of the keratocysts did not have an influence on the recurrence rate.     

Odontogenic Keratocyst: To Decompress or Not to Decompress? A Comparative Study of Decompression and Enucleation Versus Resection/Peripheral Ostectomy

PURPOSE: We discuss the outcome of 2 well-established and widely accepted methods used for the treatment of odontogenic keratocyst (OKC), enucleation with peripheral ostectomy or resection and decompression followed by enucleation and peripheral ostectomy. PATIENTS AND METHODS: A retrospective chart review of all cases of OKC treated in the University of Maryland's Department of Oral and Maxillofacial Surgery between 1994 and 2004 was undertaken. A total of 31 patients with OKCs was identified. Three of these patients diagnosed with basal cell nevus syndrome and multiple OKCs and 6 patients who did not have adequate follow-up were excluded from this study; thus, 22 patients were evaluated. Of these 22 patients, 11 were treated with resection or enucleation with peripheral ostectomy (group I) and 11 were treated with decompression followed by enucleation when indicated (group II). RESULTS: A total of 22 patients with biopsy-proven OKC ranging in age from 18 to 90 years were separated into 2 treatment arms. Group I comprised 6 females and 5 males, age 18 to 71 years, with 6 OKCs located in the mandible and 5 in the maxilla. Group II comprised 6 females and 5 males, age 24 to 90 years, with 10 OKCs in the mandible and 1 in the maxilla. The choice of treatment approach was based on the size of the cyst, recurrence status, and radiographic evidence of cortical perforation. The last follow-up revealed no recurrences in group I and 2 recurrences in group II. Both patients with recurrence in group II had undergone enucleation of the same lesion in the past, and both cysts recurred within 2 years after initial treatment. CONCLUSIONS: Our study results concur with the literature regarding recurrence rates of OKC. The aggressive nature of some OKCs necessitates equally aggressive treatment, whereas long-term follow up even for nonsyndromic patients with single lesions is of paramount importance. Age of the patient and the site and histological characteristics of the treated lesions were not significantly associated with the incidence of recurrence.     

Odontogenic keratocyst: Review of 256 cases for recurrence and clinicopathologic parameters

Odontogenic keratocyst (OKC) is of particular interest because of its high recurrence rate and aggressive behavior. Two hundred fifty-six cases of OKC were reviewed for the age of the patient at diagnosis, sex of the patient, OKC location, and radiographic findings, and 132 patients with OKC were observed to estimate recurrence, which was analyzed for age, sex, location, and several histopathologic findings. OKCs occurred more frequently in men (58.6%) than in women (41.4%), and they occurred in patients within a wide age range, most commonly in patients in the third decade of life (28.9%), followed by those in the second decade (25.0%); the mean age of patients with OKC was 30.8 years. One hundred ninety-six of the 256 cases (76.5%) occurred in the mandible, and the other 60 cases (23.5%) occurred in the maxilla. The mandibular molar and the premolar areas (51.2%) were the most common sites, and the most frequent clinical manifestations at first admission were swelling, pain, or both (82.4% of total cases). Radiographic impressions included dentigerous cyst (27.3%), OKC (25.4%), primordial cyst (14.8%), ameloblastoma (11.7%), residual cyst (9.8%), and radicular cyst (3.1%). The frequency of recurrence at the follow-up examination was 58.3%. There was no significant difference in the recurrence rate on the basis of the sex of the patient. However, OKCs had a significantly higher recurrence rate in patients in the fifth decade of life than in patients in the other age groups (P = .005).Recurrence rates were significantly dependent on the sites of involvement, and OKCs in the mandibular molar region had significantly higher recurrence rates than those in other sites (P = .001). The histopathologic presence of one or more daughter cysts was significantly related to recurrence (P = .03).     

Primary intraosseous odontogenic carcinoma arising in an odontogenic cyst or de novo: a clinicopathologic study of six new cases

The term primary intraosseous odontogenic carcinoma (PIOC) has been primarily used to describe a squamous cell carcinoma within the jaws arising either from a previous odontogenic cyst or de novo. Here, we report 6 new cases of PIOC, affecting 4 female and 2 male patients with a mean age of 56.2 years. Two cases involved the maxilla and 4 cases occurred in the mandible. The typical radiographic presentation was that of a radiolucent lesion with well or ill defined margins. Histopathologically, 4 cases were diagnosed as well differentiated keratinizing PIOC arising from previous odontogenic cysts (2 odontogenic keratocysts and 2 periapical cysts). The remaining 2 cases were poorly differentiated nonkeratinizing PIOC, which appeared to arise de novo. Treatment consisted of surgical removal, with postoperative radiotherapy in 5 cases, and to date neither recurrence nor metastasis have occurred. Knowledge of the clinical, radiographic, and histopathologic features of PIOC allows accurate diagnosis and appropriate treatment of this rare malignancy.     

Desmoplastic and non-desmoplastic ameloblastoma: a comparative clinicopathological analysis

OBJECTIVES: The aim of this study was to review a large series of ameloblastomas, accessioned during a period of 35 years in a single Oral Pathology Diagnostic Center, for the incidence of desmoplastic ameloblastoma (DA) and in order to analyze the clinical features of this unusual variant.
MATERIALS AND METHODS: All cases diagnosed as ameloblastoma were reviewed and 14 were rediagnosed as DA. These cases were analyzed in terms of gender, patient age, location, clinical diagnosis, radiographic features and recurrence following treatment. Data from DA and non-desmoplastic ameloblastoma (NDA) were compared.
RESULTS: The incidence of DA in this series was 8.8%. The mean age of NDA and DA were 39.1 and 38.8 years respectively, and a higher female prevalence was observed in the latter. The mandible was the most affected bone in both groups of tumors, but with a different regional distribution. Most NDA arose in the angle and ramus of the mandible, but the premolar/molar region was the preferential location for DA. The most common radiographic feature in DA was the osteolytic type, either monolocular or multilocular. Most of these cases were clinically diagnosed as ameloblastoma. According to follow-up data available, 21.4% of DA and 10.1% of NDA recurred.
CONCLUSIONS: The results of this study do not support the hypothesis that DA should be a separate clinicopathological entity. It seems most likely that DA is another his-tologic variant of ameloblastoma.     

复发性成釉细胞瘤的临床、影像学回顾性分析研究

目的：探讨复发性成釉细胞瘤（Recurrent ameloblastoma,RAB）的临床及影像学表现,为其诊断及治疗提供依据。方法：回顾我院1991～2008年收治的具有完整病例资料的35例RAB病例,进行Gardner分型和初次手术治疗方式的统计学分析;对23例颌骨内RAB的Gardner分型和X线分型进行分析统计;对21例行颌面部CT检查病例的影像学表现进行分析总结。结果：Gardner分型中实质型RAB最多共24例（68.6%）,软组织内RAB有12例（34.3%）;颌骨内RAB最多的X线分型多房伴蜂窝型共8例（22.9%）,CT影像可以清晰的显示成釉细胞瘤的边界、密度、形状、范围及对周围组织的累及情况。结论：成釉细胞瘤的生物学行为及术式是术后复发的主要原因;RAB易出现软组织复发及表现为多囊伴蜂窝型的X线分型;CT对RAB尤其是软组织复发成釉细胞瘤有很好的诊断价值。