开窗治疗颌骨囊性病变的专家共识

Expert consensus on marsupialization of cystic lesions of the jaw

开窗治疗颌骨囊性病变行之有效,具有创伤小、操作简单、减少术后复发,能最大程度地保留周围组织结构和功能等优点;但临床上由于适应证把握不当、操作不规范等原因,开窗治疗存在一定的失败率,文献报道的最高失败率为32.6%。为进一步完善和规范开窗术临床应用,提高治疗成功率,本文总结国内外文献和汇集部分国内著名专家的诊治经验,形成“开窗治疗颌骨囊性病变的专家共识”。此共识提出开窗术的3个要素为开窗口的建立、囊肿塞维持开窗口以及定期冲洗;开窗术的适用范围包括颌骨囊肿和囊性成釉细胞瘤等;需要规范开窗位置、开窗口大小以及囊肿塞制作与放置等重要操作步骤;对疗效评判采用全景片或锥形束CT观察术前、术后囊腔的变化较为客观;二期手术宜在病灶显著缩小>50%,或远离累及的重要结构5mm左右时实施;对于病灶牙,应根据病灶与牙的关系以及牙的类型,分别予以处理。

Marsupialization is effective in the treatment of cystic lesions of the jaw.It is a simple operation that can result in minimal trauma,the reduction of postoperative recurrence,and maximum preservation of the surrounding tis⁃sue structure and function.However,there is a certain failure rate in clinical treatment due to the improper grasp of in⁃dications and nonstandard operation.The highest failure rate reported in the literature is 32.6%.To further standardize the clinical application of marsupialization and improve the success rate of treatment,we put forward an expert consen⁃sus of marsupialization in the treatment of jaw cystic lesions by reviewing the domestic and foreign literature and sum⁃marizing the experience in marsupialization from some famous domestic experts.In this consensus,we propose three ele⁃ments of marsupialization:the establishment of the opening,the maintenance of cyst plugs and regular washing.The scope of application of marsupialization includes jaw cysts and cystic ameloblastomas.It is necessary to standardize the position of the opening,the size of the opening and the manufacture of the cyst plug,and a panoramic film or cone beam computed tomography(CBCT)should be used to observe the changes in the cystic cavity before and after operation.A second-stage operation should be performed when the lesion is significantly reduced by more than 50%or at least 5 mm from important structures;furthermore,the teeth of focus should be treated according to the relationship between the lesion and tooth and the type of tooth.