Argument for the conservative management of mandibular ameloblastomas
Argument for the conservative management of mandibular ameloblastomas
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DOI：
10.1016/j.bjoms.2016.07.017
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发表时间：
2016-11-01
影响因子：
1.8
通讯作者：
McGurk, Mark
中科院分区：
文献类型：
--
作者：
Haq, Jahrad;Siddiqui, Sarah;McGurk, Mark
成釉细胞瘤是一种罕见的良性牙源性肿瘤，下颌骨比上颌骨更常见。通常切除实性或多细胞变体并用游离皮瓣重建缺损。为了确定摘除和应用卡诺伊溶液后的结果，无论组织学亚型如何，我们使用医院的组织学数据库来识别 2001 年至 2014 年间由一名外科医生治疗的所有患者。变量包括患者特征、组织学亚型、放射学外观、随访期和复发率。总共包括 27 名患者（13 名男性），平均年龄 41 岁（范围 12-79 岁）。 15 例 (56%) 具有实性多囊性病变，总体上以滤泡型或丛状型或两者为主。在现有的 23 张术前 X 光片中，17 个病灶为单囊性，5 个病灶为多小叶和扇贝状，无间隔，1 个病灶具有多房性侵袭性特征和周边边缘不明确。平均随访时间为 38 个月（范围 3-156）。 3 名患者在术后 20、27 和 35 个月出现复发，且均再次进行剜除术并应用卡诺氏液。重建是没有必要的，迄今为止也没有再发生过。这项研究显示了保守手术和卡诺溶液囊腔灭菌的潜在好处。复发率很低，并且通过警惕的监测，必要时类似的重复程序是有效的。现在需要更长的随访期和更多的患者来证实这些发现。 (C) 2016 年由爱思唯尔有限公司代表英国口腔颌面外科医师协会出版。
Ameloblastoma is a rare, benign, odontogenic tumour that affects the mandible more commonly than the maxilla. Solid or multicytic variants are often resected and the defects reconstructed with a free flap. To establish the outcome after enucleation and application of Carnoy's solution, irrespective of histological subtype, we used the hospital's histology database to identify all the patients treated between 2001 and 2014 by one surgeon. Variables included patients' characteristics, histological subtype, radiological appearance, follow-up period, and incidence of recurrence. A total of 27 patients (13 male) were included, mean age 41 years (range 12-79). Fifteen (56%) had solid multicystic lesions, and there was an overall predominance of the follicular or plexiform variant, or both. Of the 23 preoperative radiographs that were available, 17 lesions were unicystic, 5 multilobular and scalloped with no septa, and one had aggressive features of multilocularity and a poorly defined peripheral margin. The mean duration of follow up was 38 months (range 3-156). Three patients had recurrence at 20, 27, and 35 months postoperatively, and each had repeat enucleation and application of Carnoy's solution. Reconstruction was not necessary, and to date none has recurred. This study shows the potential benefits of conservative surgery and sterilisation of the cystic cavity with Carnoy's solution. Recurrence is low, and with vigilant surveillance, similar repeat procedures have been effective when necessary. A longer follow-up period and larger numbers of patients are now needed to corroborate these findings. (C) 2016 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons.