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目的评价复发性牙源性角化囊肿外科治疗效果。方法对1998年1月至2008年3月于第四军医大学口腔医院颌面外科手术的、病历资料完整且术后经病理证实为下颌骨牙源性角化囊肿复发病例79例的临床资料进行整理,分析不同治疗方式相应治疗效果。结果79例复发性牙源性角化囊肿患者,采用保守性治疗和根治性治疗手术方式。(1)保守外科治疗后复发率为29.7%(11/37);其中单纯刮治术治疗后复发率为80.0%(8/10);刮治加微波热凝或射频消融、刮治加冷冻治疗后复发率为11.1%(3/27)。根治性治疗后复发率为2.3%(1/42)。(2)单纯刮治术治疗的复发病例平均复发时间为21.8个月;刮治加冷冻、刮治加微波热凝或射频消融术后平均复发时间为47.6个月;1例根治性治疗患者于术后4年复发。(3)保守外科治疗后病例无明显外形及功能障碍,根治性治疗有不同程度面部畸形、咬合障碍。结论复发性牙源性角化囊肿治疗首选仍为根治性治疗,但对部分病例,采用积极保守性手术治疗,可减少截骨所造成并发症,降低复发率,达到与根治性治疗相近的治疗效果。     

低温等离子射频消融技术在牙源性角化囊性瘤治疗中的应用

目的:探讨低温等离子射频消融技术联合开窗减压术,治疗下颌骨牙源性角化囊性瘤的疗效。方法 :对16例病变范围>3 cm的下颌骨牙源性角化囊性瘤患者,采用低温等离子射频消融技术消融囊壁组织,并行开窗减压术,术后3、6、12月复查,观察复发率及囊腔缩小情况。结果 :16例下颌骨牙源性角化囊性瘤经低温等离子射频消融技术结合开窗减压术治疗后,均取得较好疗效,临床及影像学检查显示,囊肿周围骨质再生改建,囊腔逐渐缩小。随访时间10~28个月,随访期间未见复发。结论 :低温等离子射频消融技术治疗下颌骨牙源性角化囊性瘤具有简单、微创、并发症少等优势,是治疗下颌骨牙源性角化囊性瘤的一种安全有效的治疗方法。     

减压术治疗青少年下颌骨大型角化囊性瘤的疗效分析

目的:探讨和评估减压术在青少年下颌骨大型牙源性角化囊性瘤治疗中的应用效果.方法:选择2005年2月-2011年2月15例下颌骨大型牙源性角化囊性瘤患者,平均年龄19.3岁,采用开窗减压术治疗,2～3个月定期随访,复拍全景片.6～12个月随访,复拍CT,囊肿直径缩小至2 cm左右时行二期囊肿刮除术.结果:减压期12～18个月,平均13.6个月.影像学显示囊肿周围新骨再生,平均囊肿缩小比例6个月时为41.5％,12个月时为61.5％,18个月时为81.8％.二期刮除术后随访1～5a,无复发病例.结论:减压术是治疗青少年下颌骨大型牙源性角化囊性瘤的首选方法.     

牙源性角化囊肿的外科治疗

牙源性角化囊肿是具有侵袭性和复发倾向的病变,术后其复发率从２．５％至６２．５％不等。因此有些学者将其归纳为良性肿瘤的范围。目前,相当一部分角化囊肿因术前未引起重视即明确诊断,而未得到正确的治疗,这是导致术后复发率较高的主要原因。本文主要报道４６例颌骨角化囊肿采用不同的方法治疗后的结果,评价临床各种治疗方法的疗效,以指导临床实践。材料与方法收集１９８２年～２０００年的临床资料,经病理学证实为牙源性角化囊肿共有４６例,且不包括基底细胞痣综合征的病例。其中１６例（３４．８％）术前未曾怀疑为角化囊肿,３…     

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。     

开窗术治疗牙源性角化囊肿

Philipsen(1956年)提出将具有角化上皮的牙源性囊肿称为“牙源性角化囊肿”。1971年WHO简化囊肿的分类,将始基囊肿和角化囊肿归为一类,但不是所有的始基囊肿都是角化囊肿。牙源性角化囊肿占颌骨囊肿的3％～     

开窗减压术治疗下颌骨大型囊性病变的临床研究

目的:通过开窗减压术治疗下颌骨大型囊性病变,探索其在下颌骨保存性功能外科中的应用价值。方法:回顾1999年10月～2004年10月治疗的107例下颌骨大型囊性病变开窗减压术病例,测量开窗减压术后病灶长径的变化,随访观察复发情况,评价临床治愈率。结果:开窗减压术治疗下颌骨大型囊性病变的总有效率为87.85%,牙源性角化囊肿的疗效优于囊性成釉细胞瘤,其中单房型角化囊肿疗效优于多房型者,单房或多房型囊性成釉细胞瘤之间疗效没有统计上差异。结论:开窗减压术是治疗颌骨大型囊性病变的有效方法。     

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     

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。     

负压吸引联合刮治术治疗牙源性颌骨角化囊肿17例分析

目的评估负压吸引联合刮治术对牙源性颌骨角化囊肿的治疗效果。方法选择近七年我科就诊的17例波及范围较大的颌骨角化囊肿患者,采用囊肿局部开窗负压吸引术进行治疗,术后随访观察2、4、6、12个月,对仍存留的颌骨囊肿行二期囊肿刮治术。结果术后2月,4例囊腔完全消失,囊腔体积缩小平均比率为65%;术后4月,11例囊肿囊腔缩小在75%以上,同期给予了刮治术;术后6月,其余2例缩小平均比率在80%以上,给予囊肿刮治术。所有病例平均治疗时长3.76个月。结论采用负压吸引联合刮治术,可有效治疗颌骨角化囊腔、缩短治疗时长。     

下颌骨大型囊性病变开窗术后骨腔改变及其影响因素

目的:观察牙源性角化囊肿(odontogenic keratocyst,OKC),单囊型成釉细胞瘤(unicystic ameloblastoma,UAB)和根尖囊肿(radicular cyst,RC)开窗减压术后骨腔的改变,并分析其影响因素。方法:27例颌骨囊性病变患者中,OKC 16例,RC 6例,UAB 5例,均行开窗减压术,术后规律随访。运用Image J软件测量术前、术后口腔曲面体层片上病变区域骨密度和囊腔大小的变化,并进行分析。结果:OKC、UAB和RC开窗减压术后,骨腔逐渐缩小,骨密度逐渐增大。术后3个月,不同病理类型颌骨囊性病变开窗减压术后愈合速度不同,差异有统计学意义(P<0.05);术后6个月,3种类型囊性病变骨密度增加速度的差异无统计学意义(P>0.05)。骨腔大小变化与初始囊腔大小有一定的相关性(P<0.05)。骨密度变化与初始囊腔大小相关(P<0.05),不同病理类型囊性病变的骨密度增加速度不同,差异有统计学意义(P<0.05)。年龄与骨腔大小变化无相关性(P>0.05)。结论:开窗减压术治疗颌骨囊性病变效果显著,初始囊腔大小及病理类型对OKC、UAB和RC的愈合有一定的影响,年龄不影响开窗减压术后成骨速度。     

A retrospective review of treatment of the odontogenic keratocyst.

PURPOSE: The purpose of this study was to evaluate different surgical treatment methods for odontogenic keratocysts and the outcome of those treatments over a 25-year period. PATIENTS AND METHODS: A retrospective review was performed of 40 patient charts treated at the University of Iowa Hospitals and Clinics (Iowa City, IA) from 1977 to 2002 with the diagnosis of odontogenic keratocyst. Demographic data were collected along with lesion location, symptoms present at initial presentation, surgical treatment rendered, length of follow-up, and incidence of recurrence. RESULTS: Surgical treatments included enucleation, enucleation with Carnoy's solution, peripheral ostectomy, peripheral ostectomy with Carnoy's solution, and en bloc resection. Recurrence was found in 9 to 40 patients. Seven of 9 recurrences (78%) occurred in 5 years or less, with 2 (22%) occurring more than 5 years after initial treatment. Patients treated with enucleation had a recurrence rate of 54.5% (6 of 11 patients). One of 2 patients treated with enucleation and Carnoy's solution had a recurrence. Those treated with peripheral ostectomy had a recurrence rate of 18.2% (2 of 11). Peripheral ostectomy with Carnoy's solution had no recurrences (0/13). CONCLUSION: Treatment of an odontogenic keratocyst with peripheral ostectomy, with or without the use of Carnoy's solution, had a significantly lower rate of recurrence. Treatment with enucleation, with or without the use of Carnoy's solution was associated with a significantly higher recurrence rate.     

Odontogenic keratocysts: review of the literature and report of sixteen cases

Sixteen cases of odontogenic keratocyst are reported. Two of the patients had basal cell nevus syndrome. The provisional diagnosis in most of the 16 cases was other than odontogenic keratocyst, and the presenting symptoms were usually swelling, pain, and sinus tract formation. The treatment varied from simple enucleation to marsupialization, homogenous bone grafting, and iliac bone grafting. There was a 25% recurrence rate, mostly associated with treatment by enucleation, cysts that were parakeratinized or difficulty in removing the lesion.     

Peripheral odontogenic keratocyst

BACKGROUND: An odontogenic keratocyst can develop at virtually any site in the jaws and is of concern because of its aggressive clinical behavior. It represents 3% to 12% of all odontogenic cysts. This paper describes the rare peripheral presentation of an odontogenic keratocyst localized to the maxillary anterior gingiva and its differential diagnosis. METHODS: A patient presented with a round yellow nodule on the maxillary gingiva between the left canine and first premolar. Clinical examination ruled out periapical abscess, periodontal abscess, and lateral periodontal cyst. A differential diagnosis included a gingival cyst, neuroma, neurilemoma, and mesenchymoma. The cyst ruptured during excisional biopsy revealing contents typical of an odontogenic keratocyst (OKC). Histology confirmed the peripheral OKC diagnosis. A conservative surgical treatment was performed assuming a less aggressive clinical course for the peripheral odontogenic keratocyst. Close follow-up was planned. RESULTS: To our knowledge, only 13 cases of peripheral OKC have been reported in the literature. Presently it is unknown if the peripheral variant shares the aggressive clinical behavior and recurrence rate of intraosseous OKC. CONCLUSION: This paper may contribute to the limited clinical knowledge base for the peripheral odontogenic keratocyst and assist clinicians in the identification and management of such lesions.     

The odontogenic keratocyst: A benign cystic tumor?

Three hundred nineteen odontogenic keratocysts from 255 patients (167 males and 88 females, a 2:1 ratio) were histologically and clinically examined. The cysts sometimes occurred as multiple or recurrent lesions or in association with Gorlin's syndrome. The rate of recurrence for the total population was 27%. The 116 patients who were tentatively diagnosed as having keratocyst prior to surgery had a recurrence rate of 26%. There was no direct correlation between a large number of different histopathologic parameters and the propensity of a lesion to recur. Based on these data, a theory for the growth mechanism of these lesions is presented, and it is that the odontogenic keratocyst should be regarded as a benign cystic neoplasm and treated accordingly.     

Marsupialization as a definitive treatment for the odontogenic keratocyst.

PURPOSE: We sought to show that marsupialization can be a definitive treatment for the odontogenic keratocyst (OKC). MATERIALS AND METHODS: Ten patients (10 males and 4 females) between the ages of 11 and 64 with biopsy-proven OKC (8 mandibular and 2 maxillary) measuring between 2 and 8 cm were treated by marsupialization consisting of excision of the overlying mucosa and the opening of a 1-cm window into the cystic cavity and, where possible, suturing of the cyst lining to the oral mucosa. Immunohistologic determination of bcl-2 was done for all samples of cyst lining. The cavities were kept open either by vigorous use of a home syringe by the patient or by suturing into place the flange and short length of a nasopharyngeal airway. Once the cyst had largely filled in, histologic material was taken from the base of the residual depression and studied by light microscopy and bcl-2 expression. RESULTS: In the 10 patients, the OKCs completely resolved both clinically and radiographically. The time taken for resolution varied from 7 to 19 months. In all cases, the histologic material obtained after marsupialization showed normal epithelium only, with no signs of cystic remnants, daughter cysts, or budding of the basal layer of the epithelium. At initial biopsy, bcl-2 was expressed in the keratocyst lining, but not in the histologic material obtained after marsupialization. Follow-up time ranged from a minimum of 1.8 years to a maximum of 4.8 years. Teeth at the periphery of the cysts were observed to upright and erupt. CONCLUSIONS: All 10 OKCs resolved completely after marsupialization. Teeth within the cyst were found to be upright and erupt. Marsupialization requires a cooperative patient who will irrigate the cavity and keep it open. It appears that the cyst lining is replaced by normal epithelium during this treatment.