负压吸引术治疗下颌骨牙源性角化囊肿

Treatment of Odontogenic Keratocyst of Mandible with Suction Drainage

目的:评价负压吸引术治疗下颌骨牙源性角化囊肿疗效。方法:15例下颌骨牙源性角化囊肿行负压吸引术治疗,观察治疗前后囊肿上皮组织形态变化,评定上皮基底膜对应区域的炎症强度分级,测量治疗前后囊腔容积和曲面断层片病变面积。结果:15例囊肿平均治疗周期为5.5月;病变缩小率为61.2%,面部膨胀畸形得以改善;术后囊肿上皮衬里炎症强度较术前显著增加,上皮转化发生率为73.3%;曲面断层片囊肿透射区域面积数值与囊腔容积呈线性相关,术后相关程度更高;刮治术后平均随访3.3年无复发病例。结论:负压吸引术能导致角化囊肿衬里上皮炎症反应,使其特征性的不全角化上皮发生转化,并较快地缩小病变范围,促进新骨形成,改善面部畸形,联合二期的刮治术可彻底清除病变、最大程度保留解剖结构及相应的生理功能。

Objective： To evaluate the effects of suction drainage on odontogenic keratocysts （OKCs） of the mandible and its role in conjunction with curettage. Methods： Biopsy and suction drainage were performed simultaneously in 15 cases of OKCs of the mandible. Clinical and radiological examinations of these patients were carried out regularly. The curettage via intraoral incision was completed until the extent of disease significantly decreased. The type of epithelial lining was recorded separately for each field （metaplastic squamous or classic parakeratinized）. The inflammatory density in the depth of each field adjacent to the basement membrane was recorded. The volume of the cavity and area of the cyst on a panoramic radiograph were measured preoperatively and postoperatively. Results： After a mean duration of suction drainage of 5.5 months, the lesion size had shrunk by a mean of 61.2% based on the panoramic radiographs findings. The contour of mandible was similar to normal after suction drainage. Microscopic examination showed substan- tial changes from a parakeratinized epithelium into a hyperplastic, stratified, nonkeratinizing squamous epithelium after suction drainage in 11 cases （73.3%）, and higher inflammatory density than preoperative. The radiolucent area of cyst on a panoramic radiograph was linearly related to the volume in the cavity, and the preoperative correlation coefficient （r） was 0. 780 （n=13, P =0. 002）, postoperative was 0. 916 （n=15, P=0. 000）. No complication occurred after curettage and no recurrence appeared with an average of follow-up 3. 3 years. Conclusion： Suction drainage is a useful treatment modality for the primary management of OKCs. It resulted in the classic parakeratinized epithelium modulated histologically to metaplastic squamous epithelium and new bone formation. Suction drainage followed by curettage via an intraoral approach, can completely remove the lesion and maximally preserve anatomical structures and physiological function of these patients.