Analysis of odontogenic keratocysts with recurrence
Analysis of odontogenic keratocysts with recurrence
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牙源性角化囊肿复发分析
DOI：
10.5794/jjoms.30.1338
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发表时间：
1984
期刊：
影响因子：
--
通讯作者：
T. Nakajima
中科院分区：
文献类型：
--
作者：
T. Yokobayashi;Y. Yokobayashi;T. Nakajima
本文报告了5例6个复发牙源性角化囊肿的临床、X线和组织学特点，其中28例随访1年以上复发率为21.4%，与文献报道的平均复发率一致。治疗后9个月~5年出现复发。结果表明，由于大多数病例没有与复发相关的症状，因此有必要进行定期和长期的随访。平均年龄16.6岁，明显低于无复发者，X线表现为单房型4例，边缘光滑或扇形，其余为多房型。3例表现为磨牙区至下颌切迹的巨大透光性病变。3例中有2例发生在牙齿承重区，其初始病变范围也超过5颗牙齿，但巨大的面积并不是复发病例的特征。5例伴有埋伏牙，但不能作为复发的原因。6例囊肿术中5例行有袋摘除、一期缝合，未发现复发，未行有袋摘除、摘除、填塞开放、摘除、填塞、切开或块切除等术式。因此，治疗方式是最重要的预后因素。由于有袋化手术的种种优点，我们仍然支持该术式用于年轻患者的囊性病变的治疗。然而，当应该在有袋手术后考虑摘除时，应尽最大努力在安全的范围内将囊肿整块切除，以包括位于骨缺损区的软组织及其周围可能附着的一层骨组织，并使伤口二次愈合。囊壁上皮岛或子囊肿的存在与复发无关。
Clinical, radiographic and histologic features of 6 recurrent odontogenic keratocysts that developed in 5 patients were described.The rate of recurrence in 28 cases with a minimum of one year follow-up was 21.4% that corresponded well to the average rate reported in other studies. The recurrence was noted 9 months to 5 years after treatment. The results indicated the necessity of regular and long-term follow-up because of the absence of symptoms associated with recurrence in most cases. The mean age of the patients was 16.6 years which was significantly lower than that of patients wthout recurrence.Radiographically, the lesions were unilocular in 4 cases with smooth or scalloping borders and multilocular in other cases. Three cases manifested themselves as huge radiolucent lesions extending from the molar area to the mandibular notch. The initial lesions were also extending over 5 teeth in 2 of 3 cases that developed in the tooth bearing area, but the huge size was not the findings characteristic of the recurrent cases. The cysts were associated with impacted teeth in 5 cases, but the condition could not be regarded as the cause of recurrence. In terms of location, there was no predilecton in the site of recurrence.Five of the 6 cysts had been treated by marsupialization followed by enucleation and primary closure, whereas recurrence was found in no case in which marsupialization, marsupialization followed by enucleation and packing open, enucleation and packing open or block resection were performed. Thus, treatment modality was the most important prognostic factor. Because of the various advantages of marsupialization, we are still in favor of the procedure in the treatment of the cyst occurring in young patients. When enucleation should be considered after marsupialization, however, the utmost care should be taken to remove the cyst en bloc with a margin of safety to include the soft tissue over the areas of bony defect and a layer of the surrounding bone to which it may be adhered and leave the wound to heal secondarily.The presence of epithelial islands or daughter cysts in the cystic wall could not be correlated the recurrence.