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(odontogenic keratocyst,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OKC 1.6∶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.     

669例牙源性颌骨囊肿临床分析

目的 :比较角化囊肿、根端囊肿、含牙囊肿等三型牙源性颌骨囊肿的临床特点。方法 :收集 2 0年间牙源性角化囊肿 (odontogenickeratocyst,OKC)、根端囊肿 (radicularcyst ,RC)及含牙囊肿 (dentigerouscyst ,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 :OKC 1.6∶1,RC 1.4∶1,DC 4.1∶1(x2 检验 ,P <0 .0 0 5 )。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 (x2 检验 ,P <0 .0 0 5 )。OKC及RC 2 0～ 2 9岁年龄段患病人数最多 ,分别占各年龄段患病人数的 2 7%及 2 0 % ;DC 10～ 19岁年龄段患病人数最多 ,占各年龄段患病人数的 2 9%。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 (x2 检验 ,P <0 .0 0 5 )。OKC以下颌磨牙区发生率最高 ( 5 5 % ) ,其次为下颌前磨牙区( 4 1% ) ;RC及DC则以上颌前牙区发生率最高 ,二者的发生率分别为 5 7%与 75 %。④OKC有 13 7例合并感染 ,感染率 3 9% ;RC 48例合并感染 ,感染率 2 4% ;DC 18例合并感染 ,感染率 16% ,三型间有显著性差异 (x2 检验 ,P <0 .0 0 5     

囊肿塞在颌骨囊肿袋形术后引流中的应用

目的:介绍2种囊肿塞的设计和制作特点及其在囊肿袋形术后引流中的应用。方法:根据囊肿的部位和治疗要求不同,将囊肿塞分为常规型和义齿型,分别介绍制作步骤和注意事项。结果:依囊肿造口所在区域统计,43件囊肿塞用于磨牙区32件,前磨牙区7件,前牙区4件。常规型35件,义齿型8件。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。义齿型囊肿塞具有美学和功能效果。结论:卡环固位的囊肿塞适用于颌骨囊肿的引流,义齿型囊肿塞还可以暂时修复失牙。     

Surgical management of dentigerous cyst and keratocystic odontogenic tumor in children: a conservative approach and 7-year follow-up

Dentigerous cyst (DC) is one of the most common odontogenic cysts of the jaws and rarely recurs. On the other hand, keratocystic odontogenic tumor (KCOT), formerly known as odontogenic keratocyst (OKC), is considered a benign unicystic or multicystic intraosseous neoplasm and one of the most aggressive odontogenic lesions presenting relatively high recurrence rate and a tendency to invade adjacent tissue. Two cases of these odontogenic lesions occurring in children are presented. They were very similar in clinical and radiographic characteristics, and both were treated by marsupialization. The treatment was chosen in order to preserve the associated permanent teeth with complementary orthodontic treatment to direct eruption of the associated permanent teeth. At 7-years of follow-up, none of the cases showed recurrence.     

Immunohistochemical analysis of P53 protein in odontogenic cysts

The p53 is a well-known tumor suppressor gene, the mutations of which are closely related to the decreased differentiation of cells. Findings of studies on immunohistochemical P53 expression in odontogenic cysts are controversial. The present study was carried-out to investigate the immunohistochemical expression of P53 protein in odontogenic cysts. Thirty paraffin blocks of diagnosed odontogenic cysts were processed to determine the immunohistochemical expression of P53 protein. Nine of the 11 odontogenic keratocysts (81.8%) expressed P53, one of three dentigerous cyst cases expressed P53, while none of the 16 radicular cysts expressed P53 protein. The findings of the present work supported the reclassification of OKC as keratocystic odontogenic tumor.     

11例颌骨单纯性骨囊肿回顾性研究

目的 探讨颌骨单纯性骨囊肿的临床、手术及放射学特点。方法 收集颌骨单纯性骨囊肿病例的资料,对其临床、影像学、手术及随访情况进行回顾性研究。结果 11例颌骨单纯性骨囊肿患者中,女性8例,男性3例。10例（90.9%）患者无症状,1例（9.1%）患者出现肿胀。所有的病例均发生于下颌骨且为孤立性病变,无外伤史。10例（90.9%）病变表现为单房,1例（9.1%）表现为多房。病变的形状可分为锥形、圆形、卵圆形、不规则形,分别有3、2、4、2例。10例行手术探查并搔刮骨壁治疗,其中7例（70%）术中发现病变骨腔为空腔,2例（20%）为浆液,1例（10%）为血性浆液。采取手术治疗的3例病变完全愈合,7例显示骨腔内有新骨形成。结论 颌骨单纯性骨囊肿通常无症状,下颌骨发病率较高,无明显外伤史,大多数病变骨腔为空腔。单纯行骨壁搔刮术是单纯性骨囊肿的一种有效的治疗方法。     

Immunohistochemical study of jaw cysts: different existence of keratins in odontogenic and non-odontogenic epithelial linings

Keratins and secretory component (SC) were immunohistochemically examined in fresh tissue samples from 45 odontogenic and 35 non-odontogenic cysts. Lining epithelia of almost all cases contained keratins which reacted with polyclonal antibodies (Dako, Bio-Science), and no difference could be found between the two groups of lesions. By staining with two monoclonal antibodies against keratins, i.e., RGE53 (Bio-Science) and RKSE60 (Bio-Science), it was revealed that the epithelia of non-odontogenic cysts, which were columnar epithelium in most cases, had fully and positively reacted with RGE53, while none of the cases was positive for RKSE60. In contrast, the squamous linings of odontogenic cysts except for two cases did not react with RGE53, and few cases possessed RKSE60-reactive keratin. SC was also contradictory. All non-odontogenic cysts exhibited SC. Regarding each pair of non-odontogenic and odontogenic cysts covered with RGE53 and SC-positive, and RKSE60-negative squamous epithelium, it seemed reasonable from the staining results to conclude that the squamous linings were metaplastic from the columnar epithelium. Based on the results, concomitant examinations of SC with keratins will be helpful in deciding the epithelial derivation of jaw cysts.     

Effects of the patient's age and the size of the primary lesion on the speed of shrinkage after marsupialisation of keratocystic odontogenic tumours,dentigerous cysts,and radicular cysts

Marsupialisation, by which a surgical window is created in the cavity of a cystic lesion, has been recommended to avoid the formation of a bony defect in the jaw and a reduction in a patient's quality of life. However, information about the factors that affect the reduction in the size of a cyst after marsupialisation is limited. We have studied the effects of the patient's age and the size of the primary lesion on the speed of shrinkage after marsupialisation of keratocystic odontogenic tumours (KCOTs), dentigerous cysts, and radicular cysts. The speed of shrinkage (mm²/month) was evaluated by measuring the radiolucent area on panoramic radiographs taken before and after marsupialisation for KCOT (n = 28), dentigerous cysts (n = 26), and radicular cysts (n = 18) in the mandibular molar regions. The mean duration of marsupialisation for each type of cyst was 11 (5), 8 (5), and 5 (2) months, respectively. The radiolucent area decreased linearly in the 3 types depending on the time after marsupialisation: r = −0.86 (p < 0.01), r = −0.73 (p < 0.01), and r = −0.72 (p < 0.01), respectively. The relative speed of shrinkage did not correlate with the age of the patients, though it did correlate with the size of the radiolucent area before marsupialisation in KCOT (r = 0.69, p < 0.01) and radicular cysts (r = 0.73, p < 0.01). These results suggest that the size of a cyst before marsupialisation may affect the speed of shrinkage in KCOT and radicular cysts, while the age of the patient does not.     

Comparative immunohistochemical expression of RANK, RANKL and OPG in radicular and dentigerous cysts

Objective

Receptor activator of nuclear factor-κB (RANK), RANK ligand (RANKL) and osteoprotegerin (OPG) are members of the superfamily of ligands and receptors of tumour necrosis factor family involved in bone metabolism. The formation, differentiation and activity of osteoclasts are regulated by these proteins. To clarify the roles of osteoclast regulatory factors in cystic expansion of odontogenic cysts, expression of these proteins were analysed in radicular and dentigerous cysts.

Design

The immunohistochemistry expression of these biomarkers were evaluated and measured in lining epithelium and fibrous capsule of the radicular (n = 20) and dentigerous cysts (n = 20).

Results

A similar expression in lining epithelium was observed in the lesions. The fibrous capsule of dentigerous cyst showed a higher content of RANK-positive and RANKL-positive cells than fibrous capsule of radicular cyst. In the lining epithelium the RANKL/OPG ratio showed higher numbers of OPG-positive than RANKL-positive cells, whereas fibrous capsule of the cysts had a tendency to present a similar expression (OPG = RANKL).

Conclusion

Ours findings indicate the presence of RANK, RANKL and OPG in cysts. Moreover, increased expression of OPG compared to RANKL in the lining epithelium could contribute to the differential bone resorption activity in theses lesions.     

HA人工骨修复较大颌骨囊肿骨腔的临床探讨

本文对近10年来应用HA修复颌骨囊肿186例，及其中较大颌骨囊肿34例，进行了较系统的临床研究。手术切口一期愈合、外形满意27例（79．5％），较明显颗粒逸漏21例（61.7%），迟发性血清肿4例（2.9％）。并对4例单囊性角化囊肿用液氮冷冻后HA修复，经3年以上随访无复发。     

Cell block technique as a complementary method in the clinical diagnosis of cyst-like lesions of the jaw

Objective

To evaluate the applicability of the cell block technique as a complementary method for presumptive diagnosis in the analysis of cyst-like aspirates from jaw lesions prior to histopathological diagnosis.

Material and Methods

The sample was made up of 17 cyst-like jaw lesions. After puncture, the aspirates were centrifuged, fixed in formalin, embedded in paraffin and processed. All lesions were biopsied and submitted to histopathological examination.

Results

In 9 cases, the cytopathological analysis using the cell block method showed a predominant presence of erythrocytes, inflammatory cells and few epithelial cells. In the other 8 cases, the cell block technique demonstrated the presence of parakeratin, whose histopathological analysis confirmed the occurrence of keratocystic odontogenic tumors (KOTs).

Conclusions

According to the studied cases, the cell block method was proven to be a simple, fast and low-cost technique to effectively differentiate KOTs from other lesions with similar clinical and radiographic features. The cell block technique comprises cellular preparations useful to determine a clinical diagnosis and help to develop a therapeutic plan for those lesions.     

Identification and characterization of gelatinases/type IV collagenases in jaw cysts

The molecular mechanisms of jaw cyst expansion probably involve interactions of matrix metalloproteinases (MMPs) and the tissue inhibitors of MMPs (TIMPs). In this study, molecular species of gelatinases present in neutral salt extracts of cyst walls and cyst fluids were characterized by functional activity measurements (type I gelatin and α-casein zymography) and immunologically (Western-blotting). The effects of various protein thiol-group or cysteine-switch reactants involved in the activation of collagenases were studied on cyst gelatinases and a gelatinases purified from human gingival fibroblasts (72 kD MMP-2), gingival keratinocytes (92 kD MMP-9) and polymorphonuclear neutrophilic leukocytes (92 kD MMP-9). Western-blottings revealed the presence of both 92 kD (MMP-9) and 72 kD (MMP-2) gelatinases in cyst wall extracts and cyst fluids. Western-blot studies further suggested that jaw cyst gelatinases were only in part complexed with and thus inhibited by TIMP-1 or TIMP-2, suggesting that both MMP-9 and MMP-2 may participate in cyst expansion. MMP-2 was also partially fragmented to a 68 kD form and additional lower molecular weight proteinases (<60 kD) were detected by α-casein zymography and by Western-blotting, suggesting proteolytic fragmentation. MMP-9 was at least partially activated by all protein-thiol group reactants and rather resistant to oxidative inhibition by hypochlorite (NaOCl); in contrast, MMP-2 was activated by APMA but not at all by gold thioglucose (GTG) and was clearly inactivated by hypochlorite (NaOCl). This indicates MMP-specific sensitivity to oxidative agents, but more specifically to preferential oxidative activation of PMN 92 kD MMP-9 and oxidative inactivation of the fibroblast-type 72 kD MMP-2.     

Jaw cysts with orthokeratinization: analysis of 12 cases

The clinico-pathologic, immunohistochemical and radiological features of 12 jaw cysts with a prominent orthokeratinized epithelial lining were studied and compared with those of typical odontogenic keratocysts and dentigerous cysts. They differed significantly from odontogenic keratocysts in terms of biologic behavior and histopathologic findings. Although immunohistochemical staining of the epithelial linings for cytokeratins. EMA, CEA and involucrin has not shed any light on the histogenesis of these lesions, staining patterns for these markers were significantly different from those of odontogenic keratocysts and non-keratinized dentigerous cysts. Radiologically, nine cases appeared as dentigerous cysts; two cases, one with sebaceous differentiation, as non-dentigerous unilocular cysts, and the remaining one was exceptional as it showed multiple epidermal cysts with prominent dermal appendages histologically. It is suggested that most of the orthokeratinized jaw cysts may belong to ctinko-pathological entities different from odontogenic keralocysts with the majority representing dentigerous cysts with orthokeratinization. The possibility of the existence of rare central dermoid or epidermoid cysts is also to be considered.     

牙源性囊肿及成釉细胞瘤细胞核DNA定量研究

目的　探讨角化囊肿、根尖囊肿、含牙囊肿和成釉细胞瘤上皮细胞的增殖特点。方法对角化囊肿、根尖囊肿、含牙囊肿上皮基底细胞和棘细胞及成釉细胞瘤外周柱状细胞和中央星网状细胞进行细胞核DNA含量测定 ,结合倍体和直方图分析。结果　牙源性角化囊肿及成釉细胞瘤细胞DNA增殖倍体含量较高 ,细胞增殖相对活跃。角化囊肿棘细胞增殖较基底细胞活跃。根尖囊肿DNA含量高与炎症刺激细胞增生有关 ,含牙囊肿细胞增殖不活跃。结论　细胞增殖活跃可能是牙源性角化囊肿及成釉细胞瘤具有局部侵袭性生长行为的生物学基础     

复发性牙源性角化囊肿刮除及冷冻治疗的效果评价

目的：探讨颌骨角化囊肿术后复发的刮除及冷冻治疗效果.方法：1994～2004年间,对10例颌骨角化囊肿术后复发病例,采用囊肿刮除联合冷冻治疗.冷冻方法为直接接触法,即刮除囊壁后,用血管钳将蘸有液氮的棉球送入囊腔,对囊腔骨壁进行冷冻;冷冻时间一般为3～5min,冻融3个周期.治疗后随访5～10a,定期进行临床及X线检查,评价治疗效果和并发症.结果：10例颌骨角化囊肿术后复发患者,经刮除及冷冻治疗后,效果良好,随访期内均无复发.1例因冻伤周围软组织,伤口延期愈合;1例发生下颌骨病理性骨折,经颌间结扎处理,骨折愈合.结论：颌骨角化囊肿术后复发应用刮除及冷冻治疗,远期效果良好,复发率低,减少了以往截骨手术的痛苦,患者容易接受,具有临床推广价值.     

Necrotizing Fasciitis of the Chest Wall Caused by Infected Dentigerous Cyst: A Case Report

Necrotizing fasciitis of the chest wall is a fairly uncommon condition. Early diagnosis and treatment is the two main factors responsible for the prognosis. Odontogenic cause of the necrotizing fasciitis of the chest wall is a rare phenomenon. It can be easily missed during the initial examination. Mortality still remains high in necrotizing fasciitis despite the use of modern powerful antibiotics and advances in the care of critically ill patients. The disease manifestation can range from a fulminant presentation to a subtle and insidious development. In this paper we are presenting a case of necrotizing fasciitis of chest wall caused by infected dentigerous cyst.     

Surgical management of odontogenic cysts involving the maxillary sinus- a retrospective study

ObjectiveTo describe our strategy for the management of odontogenic cysts involving the maxillary sinus, and to define the role of transnasal endoscopic sinus surgery in the treatment algorithm.MethodsA retrospective study was conducted. Included were all consecutive patients with odontogenic cysts involving the maxillary sinus who were treated in a single medical center between 2011 and 2019. Their medical records were reviewed for demographic data, preoperative presentation, surgical approach, final pathology, and postoperative course. Odontogenic cysts were classified as small or large according to maxillary sinus extension within or beyond the alveolar recess, respectively.ResultsA total of 30 patients with odontogenic cysts involving the maxillary sinus were treated by a team of maxillofacial and endoscopic sinus surgeons during the study period. There were 11 cases of dentigerous cysts, 11 radicular cysts, seven odontogenic keratocysts (OKCs), and one glandular cyst. Sixteen cases were managed by transnasal endoscopic sinus surgery alone and 14 were managed by a combined intraoral and endoscopic sinus surgery approach. A total of 22 patients had large cysts and total resection was achieved in 20 of them. There was one case of OKC recurrence during an average follow-up of 31 months. No major complications were recorded.ConclusionsThe endoscopic approach can serve as an alternative to the transalveolar or lateral window approach. The endoscopic approach is associated with low morbidity and low recurrence rates.     

硫酸钙修复颌骨囊肿术后感染原因分析及处理措施

目的分析医用硫酸钙骨粒修复颌骨囊肿缺损术后感染的可能原因,并提出预防及处理措施。方法对36例牙源性颌骨囊肿采用刮治术加医用硫酸钙骨粒植入治疗。患者术前均行颌骨曲面体层片（orthopantomography,OPT）或颌骨CT平扫加三维重建,明确囊肿位置和大小。采用颌骨囊肿刮治术加医用硫酸钙植入术进行治疗,术后观察并发症及成骨情况。结果36例牙源性颌骨囊肿患者中,8例术后1周至1个月出现感染症状,主要表现为骨腔肿胀,疼痛,局部皮温升高,其中有2例伴有全身低热,给予抗感染处理,持续根管开放引流等措施后逐渐愈合。术后复诊成骨情况满意,但与术后未感染的骨腔相比,成骨时间延长。结论医用硫酸钙植入颌骨囊肿术后应延长引流时间,加强抗感染处理,可有效减少感染的发生率。     

Lectin histochemistry of cystic jaw lesions: an aid for differential diagnosis between cystic ameloblastoma and odontogenic cysts

The binding sites for Ulex europaeus agglutinin I (UEA-I), Bandeirea simplicifolia agglutinin I (BSA-I), and peanut agglutinin (PNA) were comparatively examined in the surgical materials from 41 cases of cystic and solid ameloblastomas and 42 cases of non-neoplastic odontogenic cysts including dentigerous cyst, odontogenic keratocyst, and radicular cyst. In non-neoplastic cysts, most of epithelial lining layers gave positive binding with UEA-I and BSA-I. However, no positive reactions were obtained for these two lectins in the epithelial components of ameloblastoma, except for limited UEA-I binding to markedly keratinized tumor cells in four cases. PNA binding was irregular and did not make any clear distinction between ameloblastomas and cysts. The results suggest that the lectin staining for UEA-I and BSA-I is a useful histologic aid for differential diagnosis between cystic ameloblastoma and non-neoplastic jaw cysts.