颌骨骨纤维异常增殖症和骨化纤维瘤的临床及病理特征分析

目的探讨口腔颌面部骨纤维异常增殖症(fibrous dysplasia,FD)和骨化纤维瘤(ossifying fibroma,OF)的临床特征、影像学特征及病理特征,以提高临床诊断准确率。方法对我院1987—2011年间的骨纤维异常增殖症25例,骨化纤维瘤16例的临床资料、影像学资料和病理切片进行分析。结果本组病例中发病年龄两者无明显差异,FD平均22.56岁,OF平均28.25岁;前者的男女比为1∶1,后者为5∶3;发病部位两者均以上颌较多,分别为72.00%和62.50%,并且大多数都发生在磨牙区。X线片中FD病变透亮呈"毛玻璃状"边界不清,OF瘤界清楚,骨质有缺损破坏的阴影。病理组织学上FD中骨小梁呈多形态,不形成板状骨。OF的骨小梁有板状骨形成,但FD成熟型与OF在病理组织学上有相似性。结论 FD和OF是不同的独立疾病,明确其诊断,需结合临床、影像学及病理学进行综合分析。     

骨纤维异常增殖症及骨化纤维瘤中BMP的组织定量分析

骨纤维异常增殖症及骨化纤维瘤中ＢＭＰ的组织定量分析金岩，杨连甲已有研究证实，骨形成蛋白（ｂｏｎｅｍｏｒｐｈｏｇｅｎｅｔｉｃｐｒｏｔｅｉｎ，ＢＭＰ）以不同的形式参予骨纤维异常增殖症（ｆｉｂｒｏｕｓｄｙｓｐｌａｓｉａｏｆｂｏｎｅ，ＦＤＢ）及骨化纤维瘤（ｏ...     

颌骨骨化纤维瘤及骨纤维异常增殖症的临床与X线分析研究

本文结合临床及病理对比分析了３４例骨化纤维瘤（ＯＦ）和２０例骨纤维异常增殖症（ＦＤ）的ｘ线表现。ｘ线分析表明：①病变的境界清晰与否是鉴别两者的要点，ＯＦ中，境界清晰者占８８．３５％，ＦＤ中，境界清晰者仅占２５％，统计学分析有显著性差异（Ｐ＜０．０５。②ＯＦ多为圆形单房、多房样及密集硬化样改变，病变较局限。ＦＤ病变范围较大，以毛玻璃改变为主。③ＯＦ对牙齿及皮质骨影响大，ＦＤ则较小。④ＦＤ多见于下颌骨，ＯＦ则发生于上颌骨上颌窦区较多。     

骨纤维异常增殖症及骨化纤维瘤中骨形成蛋白的免疫组化分析

本文首次应用抗骨形成蛋白单克隆抗体(BMP-McAb)研究了骨形成蛋白(BMP)在骨纤维异常增殖症及骨化纤维瘤中的细胞定位。ABC 法染色结果显示,在骨纤维异常增殖症中,BMP 主要分布于纤维组织中,纤维母细胞、纤维细胞及胶原纤维均有较强的阳性着色,骨组织周围一些胞体较大的细胞含有丰富的 BMP,多数纤维性骨组织呈阳性染色;在骨化纤维瘤中,纤维组织多为弱阳性染色,只有骨组织周围的骨母细胞为阳性着色。实验结果进一步证实这两种病变中的骨组织的生长方式不同。此外,运用这种染色方法有助于对这两种疾病的临床病理鉴别诊断。首次发现骨纤维异常增殖症内含有丰富的 BMP,进一步证实了 BMP 与机体部分骨疾患有着较为密切的关系。     

46例颌面部骨纤维异常增殖症临床分析

目的：分析颌面部骨纤维异常增殖症（fibrous dysplasia，FD）的临床特点、影像学表现以及血清碱性磷酸酶（alkaline phosphatase，ALP）含量与临床相关因素的关系。方法：复习46例FD患者的临床资料并进行随访．测量分析FD患者单骨型、多骨型组和非FD患者对照组ALP的含量。采用SAS6．04软件包对数据进行方差分析。结果：46例患者，单骨型32例（69．6％），多骨型14例（30.4％）。FD在影像学上多无清晰边界，多见毛玻璃样型。复发病例11例．多发生于青春期之前。多骨型组术前血清ALP含量为（257．9±218.0）U／L，显著高于对照组的（58．5±31．3）U／L和单骨型组的（100．0±49．8）U／L。1例行上颌骨全切术＋赝复体修复，3例行下颌骨病变切除＋血管化腓骨肌瓣修复．1例行下颌骨病变切除＋血管化髂骨肌瓣修复，其余病例均行病变骨的修整术。术后随访4个月。4．9a，平均2．4a．所有伤口愈合良好，11例复发病例再次治疗后未见复发。结论：FD是一种纤维骨性病变，颌面部为其好发部位之一。此病无明显性别差异，血清ALP升高可能与FD病变的范围相关。可根据患者的具体情况选择不同术式，手术宜在青春期后进行。     

颌面部骨纤维异常增殖症34例临床分析

目的：分析颌面部骨纤维异常增殖症（fibrous dysplasia,FD）的临床特点、影像学表现与临床相关因素的关系。方法：复习34例FD患者的临床资料并进行随访,对照分析单骨型、多骨型影像学表现特点。结果：34例患者,单骨型27例（79.4%）,多骨型7例（20.6%）。FD在影像学上多见毛玻璃样型,边界清晰或不清晰。入院时为复发病人共9例,多发生于青春期之前,经手术治疗后未出现再次复发。术后随访3个月至6年,平均4年,所有伤口愈合良好出院,15例失访,仅1例出现术后1年半复发。结论：FD是一种纤维骨性病变,颌面部为好发部位之一。此病无性别差异,CBCT能为FD诊断分析提供较准确的影像学证据。手术方式主要为颌面部骨改形术,手术宜在20岁后进行。     

93例颌面部骨纤维异常增殖症的X线研究

对93例经病理证实的颌面部骨纤维异常增殖症(FD)的X线片分析结果表明:单骨性FD与多骨性FD的发病年龄和病变部位均有较明显差别,单骨FD有半数以上可以在X线片上看到病变的边缘,其中大多数患者甚至可以看到不连续的边缘硬化带,但多骨FD这一现象罕见。颅底骨硬化是多骨FD的特征性表现之一。单骨FD中下颌骨病变混合型和囊样型占相当比例,而多骨FD下颌病变者囊样型较少。     

骨纤维异常增殖症1例报告

骨纤维异常增殖症 ,亦称骨纤维结构不良 ,是由于纤维组织异常增生而生成的一种骨病变 ,上颌骨多于下颌骨 ,发生于下颌骨临床上报道较少 ,我科于 1997年收治 1例 ,现报告如下 :患者罗×× ,女 ,2 0岁 ,系浙江省轻工业学校学生。主诉右侧下颌牙根部舌侧肿胀 1年余、疼痛 2个月余。患者于1年多前无意中发现右侧下颌牙根部舌侧面突出 ,无疼痛不适 ,对进餐、语言等均无影响 ,无明显增长 ,2个月前感觉右侧下颌牙根部舌侧肿胀疼痛 ,触压时加剧 ,曾在当地医院服用抗炎药物治疗 ,无明显好转 ,于 1997年 9月 2 1日就诊入院查体 :Ｔ36 5℃ ,Ｒ :2 0次 …     

30例颌面部骨纤维异常增殖症诊治的临床分析

目的：总结颌面部骨纤维异常增殖症（fibrous dysplasia,FD）的临床特征、诊断和治疗经验。方法：对30例FD临床表现、X线影像学诊断和治疗进行回顾分析,并通过随访观察手术效果。结果：本病多发于青少年,病程较长,发育成熟后大多病例可停止发展。本组30例患者中20岁之前发病者占83.3%。根据临床和X线平片检查,单侧下颌FD10例;单侧上颌骨、颧骨和上颌骨、额骨、颞骨、顶骨、腭骨、蝶骨FD共23例（含上颌下颌同时发病者3例）。X线分型毛玻璃型14例（46.6%）,囊样型与硬化型各4例（13.3%）,混合型8例（26.6%）。全部病例均行铲除或磨削术,伤口一期愈合。随访2～5年,效果满意21例,较满意5例,不满意4例,满意度为86.7%。结论：对未成年患者应定期临床X线和核素检测观察。主张保守性手术治疗,力荐微创磨削术。     

Clinico-radiological study of fifty cases of fibrous dysplasia in the jaw bones

The purpose of this study was to report clinical and radiological findings of patients with fibrous dysplasia of the jaws. The subjects of this study were 50 patients with 54 lesions reported to have fibrous dysplasia at the faculty of Dentistry, Chulalongkorn University during 1971–1994. The clinical findings were retrospectively collected and the microscopic features were also confirmed. The ratio of men to women was 26:24 and the ratio of mandible to maxilla was 28:26. In 12 of all, swelling with tenderness or mild pain were noted. The most common age group was from 16 to 25 years. Two lesions (3.7%) were early small lesions with a cyst like appearance. The calcification gradually increased with age: mottled in 14 (25.9%), orange peel in 3 (5.6%), and ground glass in 34 (63%). The characteristics of this disease were painless swelling, a ground glass appearance and thinning or fade down of cortical bone particularly the loss of the lamina dura in 40 lesions (74%) and the inferior border of the mandible in 20 lesions (71.4%). In the maxillary lesions, the maxillary sinus was partially involved in 7 (28.9%), and completly involved in 13 (50%). These maxillary lesions confined to only one site. In the mandibular lesions, there were 9 large lesions (32.1%), all of these crossed the symphysis. Mode of the expansions occurred in all directions in 31 lesions (57.4%), bucco-lingually in 13 (24.1%), and buccally in 7 (13%).     

Juvenile ossifying fibroma of the jaw

Juvenile ossifying fibroma is a benign lesion with aggressive local growth. It is similar to an ossifying fibroma, although it is more aggressive and of earlier onset. Some cases of ossifying fibroma are part of a syndrome that includes hyperparathyroidism (caused by adenoma or carcinoma) and renal lesions, possibly caused by a recently discovered genetic mutation. These tumours must be treated by radical excision, to prevent recurrence. We report a case of recurrent juvenile ossifying fibroma, in an 18-year-old girl. The treatment was radical en-bloc resection, which was reconstructed at the same operation with an iliac crest bone graft. After one year, there has been satisfactory integration of the graft and the teeth have been implanted.     

颌骨促结缔组织增生性纤维瘤的影像特征及鉴别（附病例报道）

目的：探讨颌骨促结缔组织增生性纤维瘤（DFB）的影像学特征和鉴别诊断。方法：根据1例DFB病例进行影像学分析及文献复习。结果：DFB在X线上表现为溶骨性骨质破坏,无骨膜反应;CT上见骨小梁吸收破坏,为软组织密度肿物取代,增强检查可见强化;MRI上表现为正常骨质信号消失,软组织信号出现,T1WI为均匀等信号,T2WI为不均匀高信号。结论：DFB是罕见的起源于结缔组织的原发骨肿瘤,是具有侵袭性生长特点的良性肿瘤,治疗上宜采取术区扩大切除防止复发。因此,术前从影像学上鉴别DFB对于术式选取以及治疗效果至关重要。     

颌骨纤维异常增殖症伴牙列重度磨耗的咬合重建

目的探讨颌骨纤维异常增殖症（FD）伴牙列重度磨耗的口腔修复方法。方法对1例颌骨FD伴牙列重度磨耗的患者进行口腔系统检查与修复设计。完成修复前准备之后,试戴下颌过渡性殆垫,观察4周：行上前牙及上颌第一前磨牙牙冠延长术,4周后行上下颌牙体预备和精细临时冠桥修复,根据临时冠桥参考模型．对上下牙均行两段式钴铬生物合金烤瓷长桥修复。结果修复后患者面容对称,口唇自然美观,义齿逼真,感觉舒适,咀嚼有力,患者对修复体的临床效果满意。结论对于颌骨FD伴牙列重度磨耗患者的口腔修复．根据适应症选择合适的修复方案,进行上下颌牙列的固定桥修复可以取得良好的修复效果。     

8例青少年沙瘤样骨化纤维瘤临床分析

目的: 分析青少年沙瘤样骨化纤维瘤（juvenile psammomatoid ossifying fibroma, JPOF）的临床及影像学特点、治疗方法和预后。方法: 收集2016 年 2月—2020 年 10 月收治的8 例JPOF患者的临床及影像学资料,并进行随访,总结其临床表现、影像学特征、治疗和预后情况。结果: 8例JPOF患者,男4例,女4例,年龄（14.1±7.9）岁;发生于下颌骨3例,筛窦2例,上颌骨（窦）1例,鼻腔1例,额窦1例;病灶大小为（37.0±9.7）mm,临床表现以鼻塞、流涕、局部膨隆和疼痛多见。CT显示为蛋壳样骨壳包绕着圆形或类圆形内核的占位性病变,MRI呈现为混杂信号的囊实性肿瘤。8例JPOF均采用手术治疗,筛窦、上颌骨（窦）及鼻腔患者于鼻内镜下行病灶刮除联合周围骨磨除;额窦患者行开放性手术病灶刮除联合周围骨磨除;2例下颌骨JPOF患者行刮除术并磨除周围部分骨质,半年后复发,即再次手术;1例下颌骨JPOF患者行下颌骨节段性切除,并应用血管化髂骨肌复合组织瓣修复。随访至今均未见复发。结论: JPOF是一种发生于青少年且极为罕见的良性骨纤维性肿瘤,临床及影像学特点无特异性,主要依靠病理检查诊断,生长具有一定侵袭性,治疗方法为病灶刮除联合周围骨磨除。     

颌骨骨促结缔组织增生性纤维瘤的影像学特点和鉴别诊断

目的:探讨颌骨骨促结缔组织增生性纤维瘤的影像学征象,以提高对其诊断和鉴别诊断的准确性。方法:回顾分析8例颌骨骨促结缔组织增生性纤维瘤患者的影像学资料,其中男3例,女5例;年龄2～70岁(平均28岁);2例为上颌骨,6例为下颌骨。8例中4例有局部复发,复发的平均年限为1a。无远处转移。结果:X线平片上,病灶长轴沿上、下颌骨的长轴走向,呈现偏心性或中心性生长。骨质破坏呈膨胀性、溶骨性,肿瘤骨与正常骨之间的过渡带较窄,无明显的骨质反应线(除1例复发的小病灶外)。骨皮质膨胀变薄,无骨膜反应。病灶内部可有分房或切迹。CT像上,髓腔密度增高,正常骨小梁被软组织密度肿块所取代,软组织肿块基本均匀,病变突破骨皮质,侵犯周围组织形成肿块,肿块内无钙化和骨化。MRI上,T1WI为均匀等信号,T2WI为不均匀的高信号;增强后病灶无明显强化。波谱见胆碱波。下颌骨病变发生于下颌角、后牙区、下颌支,上颌骨发生于后牙和上颌结节区。结论:了解骨促结缔组织增生性纤维瘤的影像学特点非常重要,因其较其他的纤维性病变更具有侵袭性,手术需要更大的局部切除范围和更长期密切的随访,以防局部复发。     

Juvenile ossifying fibroma. An analysis of eight cases and a comparison with other fibro-osseous lesions

Juvenile ossifying fibroma (JOF) is a well-defined clinical and histological entity that has recently been separated from other fibro-osseous lesions, including cemento-ossifying fibromas. Its biological behaviour is well defined, but unexplained. Its behaviour, clinical and histological appearance, however, bears resemblance to osteofibrous dysplasia of long bones, a lesion that in some cases has been reported to be part of a spectrum of diseases associated with adamantinoma, thus accounting for its variable biological behaviour. Eight cases of JOF were examined for islands of epithelium or single epithelial cells using immunocytochemistry. While these cases of JOF could clearly be separated from other fibro-osseous lesions, and were histologically similar to osteofibrous dysplasia, the absence of cytokeratin-positive cells in all cases suggests that another reason for its biological behaviour has still to be found.     

Clinical characteristics of craniomaxillofacial fibrous dysplasia

BackgroundThe clinical characteristics of craniomaxillofacial fibrous dysplasia (FD) have not been clearly identified. The objective of this meta-analysis is to assess the predominance of the monostotic form of FD using an evidence-based review. Furthermore, we examined the laterality and sex dominance of FD in patients from international study populations.MethodsWe performed a systematic search of PubMed, Embase, Cochrane Central Register of Systematic Reviews, Cochrane Central Register of Controlled Trials and EBSCO for trials published through August 2013. Data extracted from the literature were analysed with Review manager 5.0.24.ResultsThe results of this study showed that unilateral FD occurred more frequently than bilateral FD (RR, 12.37; 95% CI, 2.92–61.24; P = 0.008, N = 263 patients). For unilateral FD, there was no significant difference between cases involving the left or right side of the face (RR, 0.98; 95% CI, 0.66–1.44; P = 0.91; N = 201 patients). There were no significant sex-dependent differences for monostotic and polyostotic forms of craniomaxillofacial FD.ConclusionThere is a significantly higher percentage of the unilateral form than the bilateral form in the craniomaxillofacial FD studies analysed, and an almost equal distribution of left- and right-sided unilateral FD. These proportions were maintained among males and females and there were nearly equal frequencies of monostotic and polyostotic FD.     

The natural course of an ossifying fibroma. A case report

A patient with an ossifying fibroma in the mandible is presented, with a follow-up period of 38 years. The pathological findings and recommendations for therapy are discussed.