Clinicopathologic studies on the odontogenic keratocyst
Clinicopathologic studies on the odontogenic keratocyst
复制标题
牙源性角化囊肿的临床病理学研究
DOI：
10.5794/jjoms.34.470
复制
发表时间：
1988
期刊：
影响因子：
--
通讯作者：
M. Hirokawa
中科院分区：
文献类型：
--
作者：
T. Hata;M. Hosoda;M. Fukuda;N. Segami;Sumihisa Kowaka;Hideki Hanafusa;Y. Hayashi;K. Fujimura;M. Hirokawa
牙源性角化囊肿的名称是指可能发生角化的囊肿。Philipsen在1956年的许多研究表明，这种囊肿应该被认为是一个独立的实体。本文对13例16个囊肿的临床病理资料进行了详细分析，并对其临床病理特点进行了讨论。得到以下结果.牙源性角化囊肿10例。6%的颌骨囊肿。2.最常见的部位是下颌磨牙区。患者的平均年龄为26岁。4岁以下发病率相对较高，20岁以下发病率相对较高，且以男性为主。囊液外观常呈黄色“豆腐”或黄色“泥”状.有些囊肿是X线意外发现的。影像学表现通常可描述为单房性囊性射线可透性，边缘光滑。约三分之一的囊肿与周围骨的骨组织边界相连，约一半的囊肿与阻生牙有关。2个囊肿出现根系吸收.三个囊肿（21.4%）出现复发后，平均7年3个月，所示的放射学单房外观，他们被关闭后，主要摘除。以下因素似乎站得住脚的复发机制：残留的牙板上皮内颌骨，不完全去除原来的囊肿衬里，和上皮岛内的囊肿囊。因此，此类患者应定期随访，包括术后5年或更长时间的首次X线检查。我们认为牙源性角化囊肿的治疗应是整体性的摘除术。当与周围组织粘连和/或存在骨缺损时，必须进行骨硬化和周围软组织切除。袋形术对于年轻的大的牙源性角化囊肿患者仍然是一种很好的治疗方法。在病理学特征方面，上皮岛和子囊肿是最常见的发现，尽管通常也有各种其他发现与它们一起出现。牙源性角化囊肿上皮被认为起源于牙板或其残余物、牙齿形成前的釉质器官、退化的釉质上皮和原始口腔的上皮细胞。因此，我们建议颌骨囊肿与角化上皮应被称为“角化囊肿”。三个BCNS患者（23.1%）包括在这项研究中，一个广泛而详细的家族谱系的重要性再次得到证实。
The name odontogenic keratocyst was given to cysts which may undergo keratinization. By Philipsen in 1956 many studies have since shown that this cyst should be recognized as a separate entity. Furthermore, it may be associated with the basal cell nevus syndrome (BCNS).In this paper, a detailed analysis was made of the clinicopathologic findings of 16 cysts from 13 patients experienced over a period of 12 years, and certain clinicopathologic features were discussed. The following results were obtained.1. Odontogenic keratocysts comprised 10. 6 per cent of the total jaw cysts in this study.2. The most common site was the mandibular molar region. The mean age of the patients was 26. 4 years, the frequency was relatively high below the age of 20 years, and there was a male predominance. The cyst fluids were often like yellow ‘tofu’ or yellow ‘mud’ in their appearance.3. Some cysts were found accidentally by X-ray. The radiographic appearance could be commonly described as a unilocular cystic radiolucency with a well-defined smooth periphery. About one third of the cysts were bordered by a sclerotic border of surrounding bone, and about one half of them were found in association with an impacted tooth. Root absorption was observed in 2 cysts.4. Three cysts (21.4 per cent) appeared to have recurred after a mean of 7 years 3 months, as indicated by the radiographically unilocular appearance, and they were closed primarily after extirpation. The following factors seem tenable as the mechanism of recurrence: remnants of dental lamina epithelium within the jaws, incomplete removal of the original cyst lining, and epithelial islands within the cyst capsules. Therefore, such patients should have periodic follow-up including radiographic examination for the first time 5 years or more postoperatively.5. We believe that the treatment of odontogenic keratocysts should be total enucleation en bloc. When adhesion to the surrounding tissue and/or a bone defect exists, bone curratage and excision of the surrounding soft tissue must be done. Marsupialization may be still a good procedure in young patients with large odontogenic keratocysts.6. With regard to pathologic features, epithelial islands and daughter cysts were the most common findings, although, in general, there were various other findings togethet with them. Odontogenic keratocyst epithelium is believed to originate in the dental lamina or its remnants, in the enamel organ before tooth formation, in reduced enamel epithelium, and in epithelial cells of the primitive oral cavity. Therefore, we propose that jaw cysts with keratinizing epithelium should be called ‘Keratocysts’.7. Three BCNS patients (23.1 per cent) were included in this study and the importance of a wide and detailed family pedigree was reconfirmed.