自体移植骨段上复发的成釉细胞瘤-临床及影像学分析

目的 分析自体移植骨段上复发的成釉细胞瘤临床和影像学特点。方法 收集自1958-2004年就诊于北京大学口腔医学院的6例自体骨移植段上复发的成釉细胞瘤，进行了临床及影像学分析。6例均原发于下颌骨。手术中分别采用了自体肋骨或髂骨移植。结果 复发时间最短4年，最长38．5年，平均24．4年。4例复发时无特殊的临床表现，1例植骨区有轻度膨胀，另1例表现为植骨区软组织外突肿物增长迅速。6例均病理证实为成釉细胞瘤复发，其中1例部分恶变。影像学表现为：①多房型：房室大小相差不多3例，呈蜂窝样l例，房室大小相差悬殊破坏广泛有多房遗迹1例；②单房型1例。结论 成釉细胞瘤可以在植骨术后很长时间于移植骨段上复发，因此进行长期X线复查是必要的。复发病变在影像表现上与原发成釉细胞瘤类似。     

复发性成釉细胞瘤的临床、影像、病理学分析

目的对复发性成釉细胞瘤（RAB）的临床、影像、病理学进行综合分析,为其诊断和治疗提供依据。方法对南京大学口腔医院1996年1月-2008年3月收治的具有完整病例资料的23例RAB患者的临床资料进行总结,并进行影像学和病理学分型。结果23例RAB患者中,有20例复发1次,3例复发2次,共复发26次。23例患者中,19例首次手术治疗采用刮治术,4例首次手术治疗采用根治术;复发后4例患者采用刮治术,19例患者采用根治术。26例次RAB的影像学分型：12例次为多房型,6例次为单房型,8例次为外周型;病理分型：21例次为滤泡型,5例次为丛状型。刮治术后复发者以多房型最多（11例次）,根治术后复发者以外周型最多（8例次）。结论刮治术后成釉细胞瘤复发率明显高于根治术后;滤泡型成釉细胞瘤浸润性较强,易于复发。     

发育期青少年下颌骨成釉细胞瘤治疗探讨

目的：探讨治疗年轻成釉细胞瘤患者保留下颌骨连续性临床应用效果。方法：对发育期青少年下颌骨成釉细胞瘤患者,采用保留下颌骨连续性的刮治＋磨削＋烧灼术治疗方法,观察其治疗效果。结果：本文17例患者术后发生面部畸形2例,发生率为11．8％;发生咀嚼功能障碍4例,发生率为23．5％。术后随访1-5年,没有复发病例。结论：对年轻的成釉细胞瘤患者应用刮治、磨削、烧灼术,能有效去除肿瘤,保留了下颌骨连续性,减少和减轻了面部畸形的发生以及术后功能障碍的发生,是一种切实可行、方便有效的治疗方法。     

自体移植骨中复发性成釉细胞瘤2例报告及文献复习

报告2例因右下颌骨成釉细胞瘤行右侧下颌骨部分切除或半侧下颌骨切除术后即刻分别行自体髂骨或肋骨移植的病例,2例病例在行X线检查时分别于术后16年和14年在移植骨中发现成釉细胞瘤复发。例1行术中冷冻切片活检,病理学诊断为滤泡型成釉细胞瘤。结合本组2例病例,并对已发表的文献进行复习,认为成釉细胞瘤发生在肿瘤切除植骨后的骨中属于罕见病例,应对其复发机制进行深入研究。     

颌骨恶性成釉细胞瘤10例报道

目的：探讨恶性成釉细胞瘤的临床表现、X线特征及治疗方法。方法：复习上海第二医科大学附属第九人民医院口腔颌面外科1991～2003年以来收治的10例恶性成釉细胞瘤(均经病理证实)患者，随访1～8a，对临床表现、诊断、治疗效果等进行回顾性分析。结果：10例患者中，男性5例，女性5例；年龄最大60岁，最小22岁；上颌骨4例，下颌骨6例。除2例自动放弃手术治疗外，其余均行颌骨部分切除，改良根治性或肩胛舌骨上颈淋巴清扫术，同期皮瓣修复，创口愈合良好。获得随访者，外观及功能恢复满意，无复发。结论：恶性成釉细胞瘤是一种低度恶性肿瘤，手术是其唯一根治方法。     

108例颌骨成釉细胞瘤临床分析

目的:回顾108例成釉细胞瘤的发病年龄、性别、部位、病理类型、手术方式及预后,探讨其内在联系。方法:108例患者按年龄分为7组,分析各年龄段成釉细胞瘤的发生比例、发病部位、病理类型以及复发率;探讨成釉细胞瘤各病理类型与发病部位及复发率的关系;分析手术方式和复发率的关系。结果:108例患者中,20～39岁占56.48%;男性略多于女性;下颌骨发生比例为81.48%;滤泡型占45.37%、丛状型占62.96%。108例患者平均复发率为32.41%,50岁以上者更高;65例患者刮治术后复发率为43.08%,而43例患者根治术后复发率为16.28%;各病理类型复发率分析,滤泡型为34.69%,丛状型为26.47%,棘皮瘤型和颗粒细胞型各为28.57%。结论:成釉细胞瘤以男性青壮年好发,多见于下颌骨磨牙区、下颌支及下颌角部;滤泡型和丛状型为最常见的病理类型,滤泡型较易复发;与刮治术相比,根治性手术可降低复发率。     

下颌骨成釉细胞瘤开窗刮治术术后复发一例报告

成釉细胞瘤（Ameloblastoma）有局部浸润特点,并有一定的复发率,开窗刮治术作为治疗成釉细胞瘤的一种手术方法,因其既能缩小肿瘤组织,减少手术创伤及术后复发,又能最大限度减少对颌面部功能与外形的影响,正越来越多地应用于临床。我们收治一例下颌骨成釉细胞瘤开窗刮治术术后复发病例，报导如下：     

彻底刮治术治疗下颌骨成釉细胞瘤的临床研究

目的:探讨彻底刮治术治疗下颌骨成釉细胞瘤的可能性。方法:选取临床中碰到的11例下颌骨成釉细胞瘤患者,采用彻底刮治术治疗,术后密切随访,观察患者术后有无复发及骨质是否得到恢复。结果:术后2年内,要求患者每3月进行1次复查并摄曲面体层片或CT检查,11例患者中仅有1人出现复发情况,另外10例患者术前术后CT或者曲面断层片的对比显示,骨质出现了再次生长的现象。结论:彻底刮治术治疗下颌骨成釉细胞瘤效果可观,临床可推广。     

分期治疗实性型成釉细胞瘤的初步疗效观察

目的 探讨实性型成釉细胞瘤分期治疗的可行性.方法 对13例实性型成釉细胞瘤患者采取分期手术治疗,一期采用刮除术加开窗术治疗,二期手术去除残余组织并磨除相邻骨质,术后定期X线片追踪观察疗效.结果 13例患者中3例患者一期手术后失访.10 例经术后1～4年追踪观察,9例效果满意,原肿瘤区骨质恢复良好,未见复发,l例患者在二期手术后24个月复发.结论 实性型成釉细胞瘤采用分期治疗法确切可行.     

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。     

Risk factors for recurrence of ameloblastoma: a long-term follow-up retrospective study

Ameloblastoma is a benign odontogenic tumour showing locally aggressive characteristics. This retrospective study was performed to investigate the long-term treatment outcomes of ameloblastoma and to evaluate the risk factors for recurrence. The study was conducted in the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, the University of Hong Kong and covered the years 1990–2017. Patient demographic data, radiographic pattern and findings, clinical findings, tumour site and size, World Health Organization classification, treatment modality, histological pattern, duration of follow-up, and timing of recurrence were recorded and analyzed. The potential risk factors were analyzed by Kaplan–Meier and Cox regression tests. The cases of a total of 128 patients were reviewed; 65 were male and 63 were female. The mean follow-up period was 117 months. The 5-, 10-, and 15-year recurrence rates were 9.3%, 17.6%, and 24.4%, respectively. Kaplan–Meier and Cox regression tests showed that recurrence was significantly associated with radiographic pattern, tumour size, and treatment modality. Multiple regression analysis for these three variables demonstrated that treatment modality was the only independent prognostic factor for recurrence. This study showed that radical resection is the only significant factor for a low recurrence rate of ameloblastoma and patients require long-term follow-up for late-onset recurrence.     

Central mucoepidermoid carcinoma of the mandible: report of four cases with long-term follow-up

Central mucoepidermoid carcinomas are uncommon tumours, representing about 2 to 4% of all mucoepidermoid carcinomas. They are histologically low-grade cancers, usually affecting the mandible as uni- or multilocular radiographic lesions. The authors report four cases of central mucoepidermoid carcinomas affecting the mandible and discuss their clinical, radiographic and histological findings. Four females were affected, with a mean age of 42 years and all cases involved the posterior mandible. Treatment included surgery in three cases and surgery associated to neck dissection and radiotherapy in one case. Two patients showed no recurrence and were alive without signs of the disease after a mean follow-up of 78 months. The other two patients showed local recurrence and one was alive with disease after a follow-up of 384 months, and the other was followed-up for 324 months dying by other causes without signs of the tumour. Central mucoepidermoid carcinomas of the mandible are low-grade tumours, and effective surgical treatment involving wide local excision or en bloc resection allows patients to have a favourable prognosis after long-term follow-up.     

复发与初发性牙源性角化囊肿临床、X线及组织病理学特点对比研究

目的　研究复发性牙源性角化囊肿的临床、X线和组织病理学特征。方法　对 2 1例复发性角化囊肿与其初发性角化囊肿的临床、X线和组织病理学表现进行对比分析。结果　 2 1例中 17例仅复发一次 ,5年内复发者 14例 ,复发时年龄在 10～ 2 9岁间的患者有 13例。 4例二次复发 ,3年内复发者 3例。复发性囊肿以单房影像为主 ,5例呈多房影像的初发囊肿复发时仍为多房病损。复发性囊肿组织病理学表现以典型不全角化型为主。结论　角化囊肿多在术后 5年内复发 ,低年龄组中初发囊肿体积较大、呈多房表现者复发率较高。应首选刮切术及全部拔除病变涉及的患牙。角化囊肿可能存在着不同的生长特性。     

Ameloblastoma: a clinical, radiographic, and histopathologic analysis of 71 cases

OBJECTIVES: The purpose of this study was to compare the clinical, radiologic, and histopathologic features of 71 intraosseous ameloblastomas. STUDY DESIGN: Data with respect to the patients' ages, sex, tumor locations, and surgical treatment history, as well as the radiographic findings and number of recurrences, were analyzed. The histologic types of and radiologic findings regarding tumors with higher recurrence rates were also investigated. RESULTS: The patients' ages at biopsy ranged from 11 to 70 years (mean, 30.4 years). Thirty-nine (54.9%) of the 71 subjects were males, and 32 (45.1%) were females. Sixty-two (87.3%) of the 71 ameloblastomas were located in the mandible. Swelling was the most common symptom and was experienced by 27 (38.0%) patients. Radiographically, 42 (59.2%) of the 71 tumors were unilocular with a well-demarcated border. Of the remaining 29 cases, 14 were multilocular, 2 were of soap-bubble shape, and 13 were unknown in appearance. The most common histologic pattern was plexiform, rather than follicular or acanthomatous. Sixteen cases of ameloblastoma had developed in a cyst. The overall recurrence rate was 21.1%, and the average age of the patient at recurrence was 26.4 years. CONCLUSIONS: When the diagnosis of ameloblastoma in young people remains in doubt after clinical and radiologic examination, a biopsy is necessary. Long-term follow-up at regular intervals after surgery is also recommended.     

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。     

Radiological and histological study of osteomyelitis of the jaws

Fifty-six patients with maxillary and mandibular osteomyelitis were investigated radiologically and histopathologically. The radiographic changes were classified into 5 patterns: osteolytic, mixed, sclerosing, sequestrum and irregular trabeculation patterns. Osteomyelitis was classified into 3 histological types, based on the amount of bony trabeculae present. Type I bone consisted of severely sclerotic bone, type II bone had coarse trabeculae with fibrotic marrow spaces. In contrast, type III bone had thin trabeculae with occasional osteoblastemata. The correlations between the radiographic and histological patterns and differences between acute and chronic cases were examined. Acute cases were often of the osteolytic or sequestrum patterns, and had type I or II bone. Type II bone was the most common, and was found in all radiographic types. Type III bone was frequently seen in cases with an osteolytic or mixed radiographic pattern. It seemed that severely sclerotic bone with narrowed or occluded Haversian canals (type I bone) tended to develop following acute infection. A possible explanation of the relationship of 5 radiographic types is also discussed.     

Conservative treatment protocol of odontogenic keratocyst: a preliminary study.

PURPOSE: The objective of this study was to report our experience with the treatment of 30 odontogenic keratocyst (OKC) patients with a conservative treatment protocol based on decompression with reference to the recurrence rate. PATIENTS AND METHODS: Twenty-eight patients (19 females, 9 males) with 30 OKCs attended the OMS Department of the Piracicaba Dental School of Campinas State University between 1995 and 2003. Age range was 13 to 69 years (mean, 30 years of age). Initial biopsy was carried out in all patients and the OKCs were diagnosed after histological examination by the Oral Pathology Department. The cases were treated according to the treatment employed in this department, consisting mainly of decompression and curettage of the remaining lesion. The average follow-up for the 28 cases was 24.89 months (+/-9.74). RESULTS: The majority of the lesions (16 patients, 53.3%) occurred in the angle of the mandible and mandibular ramus. The most common histological pattern of OKC was parakeratinized (66.6%) and 13 of 28 patients presented impacted teeth associated with the lesion. The mean time for decompression was 9.27 months. Recurrence occurred in 4 patients (14.3%) with 4 OKCs. These patients were treated initially with decompression and curettage (2 cases), or with decompression only (2 cases). All the cases were monitored continuously with panoramic radiographies and clinical evaluations. CONCLUSIONS: The treatment protocol for OKC based on decompression offers a conservative and effective option with low morbidity and similar recurrence rates to those reported in the literature. The systematic and long-term post-surgical follow-up is considered to be a key element for successful results.     

128例颊鳞癌术后复发的临床观察

目的:探讨颊黏膜鳞状细胞癌术后复发的相关因素,为进行综合治疗及其预后评价提供临床依据。方法:回顾性分析128例,首次术后病理已确诊为鳞状细胞癌并复发患者的临床、病理资料,及其复发的相关因素。结果:本组128例中,平均年龄为61.8岁。肿瘤生长方式以浸润性为主(62.3%)。首次手术时pTNM分期:pT1～2占36.3%,pT3～4占63.7%,pN1～2占22.7%。初次手术行单纯行病灶扩大切除者占44.6%,术后病理为SCCⅠ～Ⅱ级者占83.1%。第一次复发距手术的时间平均为10.9月,复发于原发部位者占77.3%。结论:颊黏膜鳞状细胞癌术后复发与年龄、肿瘤生长方式、pTNM分期有关,术后1年内为复发的高危时期。复发的部位大多发生在原手术区域。     

109例成釉细胞瘤病理类型、影像学表现、治疗方法和预后的对比研究

目的 对比研究成釉细胞瘤病理类型，影像学表现，治疗方法和预后之间的关系。方法 对109例成釉细胞瘤患者的病理分型，影像学表现，治疗方法和复发情况进行回顾性比较分析。结果 单囊型发病组多见于青少年，滤泡型和丛状型多见于青壮年组，滤泡型影像学特点为多房，房室大小不均，分隔多，囊腔局部或边缘多伴有蜂窝状表现，丛状型为多房大囊影，房室大小均一，分隔少，膨胀改变明显，少伴有蜂窝影，滤泡复发率高于其他各型。结论 成釉细胞瘤滤泡型，丛状型和单囊型在发病年龄，影像学表现各具特点，滤泡型复发率最高。     

Desmoplastic ameloblastoma: a systematic review of the cases reported in the literature

The aim of this study was to integrate the available data published on desmoplastic ameloblastoma (DA) into a comprehensive analysis of its clinical/radiographic features. As it is not clear whether the hybrid ameloblastoma has a unique biological behaviour, the clinical/radiographic features of conventional DA were compared with those of the hybrid variant. An electronic search was undertaken in May 2019. Eligibility criteria included publications with sufficient clinical/radiographic/histological information to confirm the diagnosis. A total of 128 publications reporting 285 DAs were included (246 central non-hybrid, 33 central hybrid, 6 peripheral). There was a statistically significant difference between non-hybrid and hybrid cases concerning lesion location, radiographic limits, and size. In contrast to non-hybrid tumours, which showed a similar distribution in the mandible and maxilla, hybrid tumours showed a high predominance of mandible location. Non-hybrid lesions more often showed ill-defined radiographic margins, and were smaller tumours than hybrid DAs. Enucleation with an additional therapy (either curettage or peripheral osteotomy) or resection led to a lower recurrence risk in comparison to curettage or enucleation without additional therapy. The location of the lesion and type of treatment are related to tumour recurrence. There are important differences in location and radiographic limits between hybrid and non-hybrid DAs, which support their classification as distinct lesions.