复发性牙源性角化囊肿的临床和影像学特点

Clinical and Radiological Characteristics of Recurrent Odontogenic Keratocysts

目的:报告复发性牙源性角化囊肿的临床、影像学特点以及治疗的结果。方法:在本院接受剜治术并随访1年以上的复发性牙源性角化囊肿19例,回顾性分析了患者的就诊年龄、患病部位、肿瘤累及范围、影像学表现、受累牙齿的处理、组织病理学发现和治疗结果。结果:19例复发性牙源性角化囊肿,12例为男性,7例为女性。首诊时的平均年龄为30.5岁。15个病变(78.9%)位于下颌骨,4个(21.1%)位于上颌。13例原发病变(68.4%)呈单房性密度减低影,6例(31.6%)为多房性,单∶多房比2.2∶1。剜除术后的复发时间间隔从5-124个月,15例(78.9%)复发在术后6年之内。复发病变的单∶多房比是1.1∶1。患区牙保留的6例中,3例的复发病变与牙密切相关。结论:复发性牙源性角化囊肿大多发生在剜治术或与剜治术+Carnoy’s液处理后6年内,通常表现为多房性或多灶性骨密度减低影像,并且与患区保留的牙有关。对这些病变应该考虑采用较为根治性的手术方法。

Objective： To study the characteristics of recurrent odontogenic keratocysts（OKCs） and their outcome of treatment.Methods： Nineteen patients of recurrent OKCs,which had underwent enucleation alone or in combination with Carnoy＇s solution,were retrospectively analyzed for their age,site and extent of tumor involvement,radiographic appearance,management of the affected teeth,histopathological findings,and treatment results.Results： Of 19 patients with recurrent OKCs,12 patients were male.The mean age of patients was 30.5 years.Fifteen lesions（78.9%） were located in the mandible,and 4（21.1%） were located in the maxilla.Radiographically,the unilocular-multilocular ratio of 19 primary cysts was 2.2∶1.The time interval between enucleation and presentation of first recurrence ranged from 5 months to 124 months,and 15 recurrences（78.9%） were diagnosed within the postoperative 6 years.The unilocular-multilocular ratio of recurrence tumors was 1.1∶1.Of 6 cases with keratocyst-involved teeth without enucleation,3 recurrent lesions were closely related to the roots of tooth.All recurrent OKCs were histopathologically appeared as parakeratin type.Conclusion： Recurrence OKCs were mostly diagnosed within the first 6 years after enucleation or enucleation with Carnoy＇s solution,usually appeared as multilocular or multicentric radiolucency and associated with teeth or tooth in the sites of involvement.The method of operation for these lesions would be considered more aggressively.