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牙源性囊肿是一组常见于颌骨内的良性病变,一般可根据临床体征和影像学发现作出初步诊断。颌骨牙源性囊肿的手术治疗方法应根据囊肿类型、患者年龄、病变大小及罹患部位等决定。青少年含牙囊肿,预期囊内含牙可自行萌出者,可采用袋形术。病变范围较小的颌骨牙源性囊肿,刮除术为最好的治疗方法。若根尖周囊肿的病源牙可保留,术前应完成根管治疗。术中辅以Carnoy液处理囊壁可减少角化囊肿术后复发。破坏范围大的颌骨牙源性囊肿可选择第一期袋形术,第二期刮除术,有利于减少邻近结构的损伤。颌骨切除术较少应用于治疗颌骨囊肿,主要适应证是病变破坏范围大,多次复发的牙源性角化囊肿。

Diagnosis and surgical treatment for odontogenic cysts

Odontogenic cysts are a group of benign lesions usually occurring in the jaws. Clinical diagnosis is often made by clinical features and radiographical findings which are an unilocular or multilocular radiolucency. Surgical treatment of these lesions is based on the patient’s age， type and size of lesion and involvment of adjacent structures. Marsupialization is especially indicated for younger dentigerous cysts if the tooth in the cyst is expected to erupte postopratively. Enucleation is usually used for smaller odontogenic cysts. Endodontic therapy shall be completed preoperatively if affending tooth or teeth of periapical cyst will be preserved. Recurrence rate may be reduced after enucleation when the Carnoy’ solution is applied to treating the cyst lining or residual tissue of odontogenic keratocysts. Marsupialization followed by secondary enucleation is a choice of treatment for large odontogenic cysts， which will significantly decrease damage on associated adjacent structures. Radical resection with continuity or discontinuity defect is only indicated for extensive and multiple recurrence keratocysts after conservative surgery.