巨大下颌骨囊性病变分期治疗效果评价

Therapeutic effect of staged treatment for huge mandibular cystic lesions

目的：探讨对巨大下颌骨囊性病变进行分期治疗的效果。方法：选择2005—2009年在本院收治的下颌骨范围大于5cm的囊性病变18例,其中伴牙列不齐者6例,一期局麻下行减压术,待范围减小至小于原来的1/2后,行二期全麻下囊性病变摘除术,即刻Bio-oss骨粉植入,术后每月定期拍摄口腔全景片观察骨密度变化,伴牙列不齐的6例患者手术后2个月开始以常规正畸加力牵引。结果：一期术后4－6个月,病变减小至原来的1/2左右,二期术后6~12个月,骨粉与周围正常骨密度基本一致,2~3a后无一例复发。6例牙列不齐的患者,经1－2a正畸治疗后,错畸形得以矫正。结论：分期治疗既彻底摘除了病变,又保存了下颌骨的连续性及自体牙,还可同时结合正畸治疗,改善错畸形,提高美学效果。

PURPOSE：To investigate the therapeutic effect of staged treatment for huge mandibular cystic lesions.METHODS： The study enrolled 18 cases of huge cystic lesions whose extent in X-ray film exceeded 5 cm from 2005 to 2009 in our hospital,6 of them presented mal-aligned dentition.Decompression was first given under local anesthesia to make the entire extent gradually reduced to half of its primary extent,then the cysts were enucleated secondarily combined with simultaneous Bio-oss insertion under general anesthesia,followed by X-ray examination monthly to observe the density of bone,and normal orthodontic treatment was given to 6 cases with malocclusion.RESULTS： The lesions reduced to around half of the primary extent in 4 to 6 months after decompression,the density of bone substitute became almost similar to adjacent bone 6 to 12 months after secondary operation,no case had recurrence within 2 to 3 years.6 cases with malocclusion were corrected after 2 to 3 years of orthodontic therapy.CONCLUSIONS： The staged treatment can retain the whole mandible and teeth at the same time of enucleation of the cyst,and achieve excellent aesthetic result combined with orthodontic therapy.Supported by Research Fund of Medical Science of Zhejiang Province（2006B125） and Research Fund of Huzhou City（2007YS28）.