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。     

口外型舌下腺囊肿36例手术治疗总结

目的:回顾性分析口外型舌下腺囊肿临床资料,评价术前诊断、手术方式与疗效的关系.方法:术前行穿刺细胞学检查,在全麻或局麻下经口内进路行舌下腺及囊肿摘除术,术后颌下加压包扎.结果:36例口外型舌下腺囊肿经口内切口行舌下腺及囊肿摘除术,颌下加压包扎,术后无复发.结论:手术完整摘除舌下腺是治愈的关键.     

下颌骨巨大根尖囊肿切除1例报告

根尖囊肿是口腔颌面外科常见病 ,多发生于颌骨某一区域 ,但波及一侧的下颌骨巨大根尖囊肿 ,临床罕见 ,兹报告 1例如下 :患者陈×× ,男 ,32岁。因右下颌包块 1年余伴快速增大 1月就诊。患者于 10年前右下颌后牙反复疼痛 ,经抗炎治疗后均好转。面检 :右下颌双尖牙区皮肤隆起明显 ,局部按压柔韧感 ,无明显压痛 ,口内 :6残根 ,5 4远中舌侧倾斜 ,松动 (- ) ,7 3颊侧牙龈隆起。 82缺失 ,舌侧龈正常 ,口底粘膜无隆起 ,开闭口活动正常 ,口唇无麻木。右下颌骨Ｘ线片示 :7 3根区有一巨大阴影 ,大小约 2 5ｃｍ× 5 0ｃｍ ,边缘整齐 ,距下颌骨下缘约 …     

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。     

脱钙冻干骨混合自体骨髓治疗下颌骨囊肿摘除术后骨缺损

目的探讨脱钙冻干骨混合自体骨髓治疗下颌骨囊肿摘除术后骨缺损的疗效。方法 42例下颌骨囊肿摘除术后采取脱钙冻干骨混合自体骨髓填充缺损,观察手术临床效果,并行术前术后放射线检查。结果 1例术后出血,2例创口延期愈合,随访13⁴8个月2例牙源性角化囊性瘤复发,其余术后愈合良好。结论脱钙冻干骨混合自体骨髓可用来治疗下颌骨囊肿摘除术后骨缺损。     

减压术治疗颌骨囊肿20例

颌骨囊肿是颌面外科一常见疾病 ,但由于其发病部位隐蔽 ,平时可无任何症状 ,难以引起患者注意 ,当发现颌骨囊肿时 ,其骨破坏程度已相当严重 ,往往需要手术治疗。我们在1995～ 2 0 0 0年采用“减压术”使囊肿变小 ,最后采用小手术的方法彻底刮治囊肿 ,从而获得了理想的效果 ,大大减轻了患者手术的痛苦 ,降低了经济费用 ,现将采用“减压术”治疗颌骨囊肿 2 0例的临床经验予以报道。1　临床资料1.1　 1995～ 2 0 0 0年我院采用“减压术”治疗颌骨囊肿 2 0例 ,其中男性 13例 ,女性 7例 ,年龄 15～ 4 0岁 ,平均年龄 30岁 ,病程 6个月至 3年不等。…     

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。     

压电超声骨刀在颌骨囊肿摘除术中的临床应用

目的：总结压电超声骨刀在颌骨囊肿摘除术中的临床应用特点,并评价其临床效果。方法：对4l例颌骨囊肿病例,应用压电超声骨刀进行骨开窗,其中8例配合使用电钻,摘除囊肿,6例囊腔用钛板将游离的自体骨块复位固定,关闭骨腔。观察超声骨刀的临床使用特点及临床效果。结果：4l例均完整摘除颌骨囊肿,其中1例因术中操作不当致鼻底黏膜损伤,其余病例无软组织损伤。伤口一期愈合。8例配合使用电钻者,骨切割效率明显提高。结论：颌骨囊肿摘除术中应用压电超声骨刀,手术精确度高,安全,方便。     

根尖囊肿保守治疗的临床应用(附65例病例分析)

目的 :观察较大的根尖囊肿经保守治疗后的疗效。方法 :采用根管引流或根尖部唇侧开窗引流后 ,根管治疗 ,根管充填剂适当超填方法保守治疗根尖囊肿。结果 :65例根尖囊肿治疗 2年后 ,痊愈占 63 79%、进步占 3 1 0 4 %、失败占 5 17%。结论 :单纯采用根管治疗可以治愈较大的根尖囊肿。     

青少年下颌骨大型牙源性角化囊肿的治疗

我科收治青少年下颌骨大型牙源性角化囊肿6例。男、女各3例。年龄13至28岁,初次治疗均行彻底刮治术。观察时间2—11年,平均六年。5例至今未复发,1例术后3年复发,采用了部分截骨及游离植骨术,术后三年已做义齿修复。     

Orthokeratinized Odontogenic Cysts Presenting as a Periapical Lesion: Report of a Case and Literature Review

Introduction

Inflammatory cysts, granulomas, abscesses, and fibrous scars represent most periapical radiolucencies. However, other less common lesions, such as orthokeratinized odontogenic cysts (OOCs), can be found at this region, and they deserve to be discussed because the prognosis for an OOC is different from that expected for the ordinary inflammatory periapical diseases.

Methods

An interesting case of OOC associated with a nonvital tooth in a 40-year-old woman is described. After a previous clinical diagnosis of a radicular cyst, the tooth was extracted, and the lesion was enucleated and submitted to microscopy examination.

Results

Because of the detection of an orthokeratinized epithelium lining, a diagnosis of OOC was concluded. After 2 years of periodic follow-up, no signs of recurrence were detected.

Conclusions

The presence of keratin in radicular lesions must be carefully evaluated to eliminate the diagnosis of lesions with more aggressive behavior, such as an OOC or even a keratocystic odontogenic tumor. Hence, histopathologic examination is mandatory to confirm the type of lesion and to differentiate other pathologic conditions, therefore establishing patients' prognoses precisely.     

负压引流器在下颌骨囊性病变中的临床应用

目的:探讨改良型负压引流器在大型下颌骨囊性病变开窗术后的临床应用。方法 :观察11例改良型负压引流器在大型下颌骨囊性病变中的应用,其中下颌骨大型角化囊性瘤10例,下颌骨单囊型成釉细胞瘤1例。遵医嘱佩戴改良型负压引流器,1个月复诊1次。结果:所有病例中,该装置均能完全与组织边缘贴合,负压保持良好。结论:改良型负压引流器是大型下颌骨囊性病变负压引流术治疗中较理想的装置。     

牙源性角化囊肿的手术治疗：保守性或根治性方法

牙源性角化囊肿（odontogenic keratocyst，OKC）因其侵袭性行为、组织学和遗传学方面的新发现，在WHO的分类中已命名为牙源性角化囊性瘤（keratocystic odontogenic tumour，KCOT）。本文复习了这种病变的生物学特点，并结合笔者的研究经验和相关文献资料分别介绍保守性和根治性治疗策略。     

The Odontogenic Jaw Cysts： Analysis of the Clinical Parameters of 669 Cases

目的分析、比较三型牙源性颌骨囊肿的临床特点.方法收集20年间牙源性角化囊肿(odontogenickeratocyst,OKC)、根端囊肿(radicular cyst,RC)及含牙囊肿(dentigerous cyst,DC)的临床资料,对其性别构成、年龄分布、发病部位及临床表现等进行比较研究.结果1)三型颌骨囊肿的男女之比分别为OKC1.6∶1,RC 1.4∶1,DC 4.1∶1(χ2检验,P＜0.005).2)除DC未见于70岁以上年龄段外,几乎各年龄段均见三型颌骨囊肿的发生,三型囊肿组间及组内的年龄分布均有显著性差异(χ2检验,P＜0.005).OKC及RC20～29岁年龄段患病人数最多,分别占各年龄段患病人数的27%及20%;DC10～19岁年龄段患病人数最多,占各年龄段患病人数的29%.3)颌骨的任一部位均见三型颌骨囊肿的发生,但发生频率不同,三型颌骨囊肿组间及组内发病部位的分布有显著性差异(χ2检验,P＜0.005).4)OKC有137例合并感染,感染率39%;RC48例合并感染,感染率24%;DC18例合并感染,感染率16%,三型间有显著性差异(χ2检验,P＜0.005).结论1)男性较女性更易发生牙源性颌骨囊肿.2)不同的年龄段,对OKC、RC及DC的易感性不同.OKC及RC发生的高峰期均为20～29岁年龄段;DC发生的高峰期为10～19岁年龄段.3)不同的颌骨部位,对OKC、RC及DC的易感性不同.OKC好发于下颌磨牙区,其次为下颌双尖牙区;RC及DC则好发于上颌前牙区.4)感染症状的出现,对OKC、RC及DC彼此间的鉴别诊断具一定临床意义.     

鳃裂囊肿及瘘43例治疗效果分析

目的：探讨鳃裂囊肿及瘘管术后复发原因及预防措施。方法：对43例鳃裂囊肿及瘘病例行手术，术前于囊管内注入美蓝液，以便术中分离追踪蓝染管支，近内口处行荷包缝合术或电凝、微波等处理。结果：43例中41例治愈，随访1年以上未见复发，2例复发，再次手术治愈，复发率4.7％。结论：对鳃裂囊肿及瘘患者，术前、术中、术后处理好每个环节，是防止复发的关键。     

周边型牙源性纤维瘤35例临床病理研究

目的 :总结周边型牙源性纤维瘤的临床病理特点。方法 :按WHO(1992 )牙源性肿瘤分类标准对 35例周边型牙源性纤维瘤的临床病理资料进行回顾性分析。结果 :35例中 ,男性 14例 ,女性 2 1例 ;平均年龄 31岁 ;上颌牙龈 14例 ,下颌牙龈 2 0例。肿块为局部软组织突出表现。X线片和手术中见五例牙槽骨有吸收改变。三例术后复发。组织学上 ,肿瘤由致密结缔组织组成 ,含数量不等的成纤维细胞 ,一例伴有颗粒细胞。肿瘤边界尚清 ,缺少明显包膜。结论 :周边型牙源性纤维瘤临床表现与龈瘤不能区分 ,组织学主要为WHO型牙源性纤维瘤 ,手术切除不彻底易复发。     

Adenomatoid Odontogenic Tumor (AOT) Arising from a Dentigerous Cyst: Literature Review and Report of a Case

Adenomatoid odontogenic tumor (AOT) is an uncommon benign tumor of odontogenic origin composed of odontogenic epithelium in a variety of histopathological patterns. These lesions are usually solid but are occasionally cystic. AOT has been reported to occur in association with odontogenic cysts. Very few cases have been described that arise in association with a dentigerous cyst. A systematic search of the English-language medical literature in PubMed and Medline search (keywords adenomatoid odontogenic tumor, dentigerous cyst) data bases revealed only ten such cases.The present case is very unique, exceptional and first of this kind that occurred in the posterior mandible associated with an impacted lower first premolar in a 19-year old female patient. The intraosseous follicular AOT, as this case reported here, frequently resemble dentigerous cysts. There is an uncertainty whether the lining of an associated cyst represents a true dentigerous cyst, cystic change within an AOT or may represent a distinct entity. We believe that this case represents an odontogenic cyst with neoplastic change. Hence, in such cases, the final diagnosis should be made on the basis of histological examination of extensive tissue sampling of entire excised tissue specimen. Further studies to determine whether the AOT derived from an odontogenic cyst could represent a distinct variant are to be done.     

下颌骨髁突骨折临床30例病例观察

目的:对30例(38侧)髁突骨折临床资料分析,探讨髁突骨折的临床特点。方法:选取大连市口腔医院口腔颌面外科2004-05─2007-10收治的资料完整的30例(38侧)髁突骨折病例,对髁突骨折的发生年龄、性别、致伤原因、骨折类型、全身损伤、治疗方案及手术并发症进行分析,并以开口度、开口型、咬合关系、咀嚼力、面型等5个方面作为术后评价标准,进行综合评价分析。结果:髁突骨折男性多于女性,交通事故伤为最主要致伤原因;髁突骨折42.11%发生在髁突基部,36.84%发生在髁突颈部。主要治疗方法是坚固内固定,正颌手术方法(下颌升支垂直截骨术)等。并发症主要为开口型偏斜(4例),开口度30mm以下(1例),术后髁突吸收(1例)。结论:髁突骨折好发于髁突颈部及基部,坚固内固定是最常用手术方法,牵引成骨技术也应用到陈旧性髁突骨折中。     

Odontogenic ghost cell carcinoma: a case report with immunohistochemical and ultrastructural characterization

Folpe AL, Tsue T, Rogerson L, Weymuller E, Oda D, True LD: Odontogenic ghost cell carcinoma: a case report with immunohistochemical and ultrastructural characterization. J Oral Pathol Med 1998; 27: 185-9. C Munksgaard, 1998. The odontogenic ghost cell tumor (OGCT) is the rare, neoplastic variant of the calcifying odontogenic cyst (COC). To date, there have been only four reports of malignant OGCTs, in five patients. We report an additional case of a malignant odontogenic ghost cell tumor that involved the right maxilla of a 20-year-old man. Our report includes its immunocytochemical and ultrastructural characterization.     

The Management of Aggressive Cysts of the Jaws

There are essentially six types of aggressive cysts of the jaws that require special attention, so as to avoid recurrence, or even worse, widespread disease. They include, botryoid cysts, cysts in which carcinoma’s arise, glandular odontogenic cysts, calcifying cystic odontogenic tumour, previously called calcifying odontogenic cyst and unicystic ameloblastoma and keratocystic odontogenic tumor, previously called odontogenic keratocysts. The estimated incidence of these cysts, based on some review studies has been discussed. The main issue, however, when treating a cyst of the jaws is; how sure can one be that the lesion is benign or potentially aggressive? In order to answer this question it is important to know how these cysts commonly present. The clinical presentation, frequency of occurrence and suggested modes of treatment has been addressed.