经口腔改良扩大刮治术治疗下颌骨巨型壁性成釉细胞瘤

目的:探讨应用经口腔改良扩大刮治术治疗下颌骨巨型壁性成釉细胞瘤的治疗效果。方法:对2000—2010年收治的18例下颌骨巨型壁性成釉细胞瘤患者采用经口腔改良扩大刮治术(经口内切口刮除肿瘤;将术后骨腔浅层内壁以磨钻磨除;再以液氮冻融2次;填塞碘仿纱条,术后定期换药至骨腔平复)进行治疗,进行定期临床和影像学随访,随访期3个月～5a,评价治疗效果。结果:术后3个月,影像学显示术后骨腔开始缩小,部分新生骨钙化;术后6个月～1a,全部病例外形及颞下颌关节功能恢复良好,影像学显示术后骨腔明显缩小,可见堆积状新骨形成,新生骨明显钙化,骨皮质影像接近正常;术后1～1.5a,原膨隆的面部基本恢复正常,影像学显示术后骨腔内大量骨小梁形成,钙化良好,牙槽突高度略差;术后3.5～5a,骨腔体积平均缩小80%～90%,最小者为40%～50%。全部病例均未见肿瘤复发。结论:经口腔改良扩大刮治术治疗下颌骨巨型壁性成釉细胞瘤能有效去除肿瘤,显著缩小囊腔,促进新骨形成,改善面部畸形,有效恢复颞下颌关节的生理功能,保存下颌骨的连续性。

Treatment of huge mandible mural ameloblastoma by modified transoral radical curettage

PURPOSE： To evaluate the effectiveness of modified transoral radical curettage on treatment of huge mandibular mural ameloblastoma.METHODS： Eighteen patients with huge mandibular mural ameloblastoma were selected and followed up for 3 months to 5 years after modified transoral radical curettage.During regular re-visit,clinical and radiological examinations of these patients were conducted and analyzed.RESULTS： Three months after operation,radiological imaging showed the cavity began to reduce and calcification could be detected in new born bone.From 6 months to 1 year postoperatively,all patients＇ appearance and function of the temporomandibular joint（TMJ） improved greatly.The cavity diminished distinctly and new born bone accumulated with calcification.Image of cortical bone seemed normal.From 1 year to 1.5 years subsequently,facial contour returned to normal.A large number of trabecular bone was produced with full calcification,while the height of alveolar bone was deficient.From 3.5 to 5 years,the lesion shrank by a mean of 80%-90%.No recurrence happened for all 18 cases.CONCLUSIONS： Modified transoral radical curettage is an effective treatment for huge mandibular mural ameloblastoma,which can decrease the cystic volume significantly,promote new bone formation,enhance facial deformity,improve TMJ function,and keep the integrity of the mandible.