Clinical study of keratocystic odontogenic tumors
Clinical study of keratocystic odontogenic tumors
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牙源性角化囊性肿瘤的临床研究
DOI：
10.5794/jjoms.54.323
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Teruo Eamagasa
中科院分区：
文献类型：
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作者：
N. Tomomatsu;Narikazu Euzawa;Y. Michi;Kazuto Ekurohara;N. Okada;Teruo Eamagasa
牙源性角化囊肿（OKC）最初被归类为发育性囊肿，OKC在组织学上分为正角化型（O-OKCs）和角化不全型（P-OKCs）。O-OKCs和P-OKCs的临床特征不同。与OOKCs相比，P-OKCs在手术治疗后有复发的倾向。根据世界卫生组织（2005年）修订的牙源性肿瘤组织病理学分类，P-OKCs采用角化囊性牙源性肿瘤（KCOT）一词。在这项回顾性研究中，我们调查了从1981年到2005年在东京医科和牙科大学医院颌面外科治疗的186例kcot。患者年龄7 ~ 85岁（平均32.7岁），男93例，女93例。最常见的受累部位是下颌磨牙区和支。上颌区的kcot大多采用去核和初级闭合治疗。大多数下颌骨区域的kcot被去核，伤口保持开放。对4例下颌骨出现较大病变的患者行边缘切除。120个病灶中有19个（15.8%）复发，随访时间超过一年。复发是在与牙根接触的原发病变边缘或在下颌分支的上边缘发现的。临床医生应考虑积极治疗KCOT，因为P-OKCs的复发率高于其他类型的囊肿，如O-OKCs、牙状囊肿、未角化的原始囊肿和轻微角化的分层鳞状上皮。因此，与其他囊性病变相比，kcot需要更积极的治疗。然而，术前很难根据临床特征和x线影像做出准确的诊断。因此，术前活检对于选择合适的治疗方法是必要的。
The odontogenic keratocyst (OKC) was originally classified as a developmental cyst, and OKCs were histologically divided into orthokeratotic (O-OKCs) and parakeratotic type (P-OKCs). Clinical features differ between O-OKCs and P-OKCs. P-OKCs have a tendency to recur after surgical treatment, as compared with OOKCs. According to the revised histopathological classification of odontogenic tumors by the World Health Organization (2005), the term keratocystic odontogenic tumor (KCOT) was adopted for P-OKCs.In this retrospective study, we examined 186 KCOTs treated at the Maxillofacial Surgery, Tokyo Medical and Dental University Hospital from 1981 through 2005. The patients ranged in age from 7 to 85 years (mean, 32.7) and consisted of 93 males and 93 females. The most frequently involved regions were the mandibular molar region and ramus. The majority of KCOTs in the maxillary region were treated by enucleation and primary closure. The majority of KCOTs in the mandibular region were enucleated, and the wound was left open. Marginal resection was performed in the 4 patients with large lesions arising in the mandible. Recurrences occurred in 19 of 120 lesions (15.8 %) in patients who were followed for more than a year. The recurrences were found at the margins of the primary lesion in contact with the roots of teeth or at the upper margins of the mandibular ramus.Clinicians should consider aggressive treatment for KCOT because the recurrence rate of P-OKCs is higher than that of the other cyst types, such as O-OKCs, dentigerous cysts, and primordial cysts that were non-keratinized, and slightly keratinized stratified squamous epithelium. Thus, more aggressive treatment is needed for KCOTs as compared with other cystic lesions. However, it is difficult to make a precise diagnosis preoperatively on the basis of clinical features and X-ray imaging. Therefore, preoperative biopsy is necessary for selecting the appropriate treatment for patients with cystic lesions.