负压吸引联合刮治术治疗下颌骨巨大单囊型成釉细胞瘤

Treatment of giant unicystic ameloblastoma of the mandible by suction drainage followed by curettage

目的:评价负压吸引联合刮治术治疗下颌骨巨大单囊型成釉细胞瘤的疗效。方法:5例下颌支巨大单囊型成釉细胞瘤活检术同期施行负压吸引术,进行定期临床和影像学随访,待病变范围明显缩小后,经口内进路完成刮治术。结果:负压吸引术后5个月,影像学显示病变范围平均缩小67%,病变区解剖结构接近正常。刮治术后,病理诊断4例为Ⅲ型单囊型成釉细胞瘤,1例为Ⅱ型单囊型成釉细胞瘤;复层鳞状上皮衬里增生明显,纤维囊壁组织内慢性炎症细胞浸润。刮治术后6～61个月,随访无复发。结论:负压吸引术作为下颌骨巨大单囊型成釉细胞瘤的初期治疗能较快地缩小病变范围,促进新骨形成,改善面部畸形,联合二期刮治术可彻底清除病变,最大限度地保留解剖结构及相应的生理功能。

PURPOSE： To prospectively investigate the treatment of giant unicystic ameloblastoma of the mandible. effectiveness of suction drainage followed by curettage for METHODS： Biopsy and suction drainage were performed simultaneously in 5 cases of large unicystic ameloblastomas of the mandibular ramus. Clinical and radiological examinations of these patients were carried out routinely. The curettage via intraoral incision was conducted until the lesions significantly shrunk. RESULTS： After a mean duration of suction drainage of 5.2 months, the lesion size shrunk by a mean of 67% based on the panoramic radiographic findings. The contour of the mandibular ascending ramus was similar to the opposite side. No complication occurred after curettage and no recurrence appeared in the follow-up of 6 to 61 months. Histologically, 4 cases were classified as Ackermann type Ⅲ unicystic ameloblastoma. Only one case was classified as type Ⅱ .Microscopy revealed a hyperplastic epithelial lining with intramural chronic inflammatory cells infiltration after suction drainage. CONCLUSION： Suction drainage is a useful treatment modality for the primary management of the giant unicystic ameloblastoma of the mandible, which, followed by curettage via an intraoral approach, can completely remove the lesion and maximally preserve the anatomical structures and physiological function of the mandible.