Odontogenic cysts

牙源性囊肿
  • 文章类型: Case Reports
    背景:尽管文献中记载了许多颌骨的综合征和非综合征牙源性病变,很少有同时发生良性和恶性颌骨病变的病例。
    方法:我们介绍了一例右上颌鳞状细胞癌,并伴有一些颌骨良性牙源性囊性病变和骨骼异常,符合Gorlin-Goltz综合征标准。
    通过对文献的回顾,讨论了管理和后续行动的细节。
    BACKGROUND: Although numerous syndromic and non-syndromic odontogenic lesions of the jaws have been documented in the literature, there are very few cases of simultaneous benign and malignant jaw lesions.
    METHODS: We present a case of right maxillary squamous cell carcinoma along with several benign odontogenic cystic lesions of the jaws and skeletal abnormalities that meet the criteria for Gorlin-Goltz syndrome.
    UNASSIGNED: With a review of the literature, the specifics of management and follow-up are discussed.
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  • 文章类型: Review
    背景:用牙源性角化囊肿重建整个牙列是一个非常具有挑战性的难题。据报道,大多数牙源性角化囊肿是良性的,导致上颌和下颌牙列严重咬合差异。牙科X光片偶尔会显示一种罕见的,局部侵袭性发展中的囊肿称为牙源性角化囊肿,通常位于后颌。当这种囊肿发生在前部区域时,由于对牙髓活力测试缺乏反应,常被误诊为其他根尖周病变。
    方法:本临床病例描述了一名诊断为牙源性角化囊肿患者的牙髓治疗。一名37岁的印度男性患者向该部门报告,左下后牙的搏动性疼痛需要进行牙髓治疗。该患者还出现了颌骨前部区域的牙源性角化囊肿,为此他接受了手术康复。此病例报告重点介绍了诊断为牙源性角化囊肿的患者的牙髓治疗的临床方案。随访期后未发现咀嚼损伤,治疗结果成功。
    结论:本病例报告详细介绍了特征性射线照相发现,和牙源性角化囊肿极为罕见的患者的牙髓治疗。管理涉及康复的多学科方法。
    BACKGROUND: Reconstruction of the entire dentition with odontogenic keratocyst is a very challenging quandary. Most cases of odontogenic keratocyst are often reported to be benign, resulting in severe occlusal discrepancies with the maxillary and mandibular dentition. Dental radiographs occasionally reveal an uncommon, locally aggressive developing cyst termed as odontogenic keratocyst, which is typically located in the posterior jaw. When this cyst occurs in the anterior region, it is often misdiagnosed with other periapical lesions due to its lack of response to pulp vitality tests.
    METHODS: This clinical case scenario demarcates the endodontic management of a patient diagnosed with odontogenic keratocyst. A 37-year-old Indian male patient reported to the department with throbbing pain in the lower left posterior tooth requiring endodontic therapy. This patient also presented with odontogenic keratocyst in the anterior region of the jaw, for which he had undergone surgical rehabilitation. This case report highlights the clinical protocol for the endodontic therapy in patient diagnosed with ododntogenic keratocyst. Masticatory impairment was not visible after the follow-up period and the treatment outcome was successful.
    CONCLUSIONS: This case report details the presentation, characteristic radiographic findings, and endodontic management of a patient with an extremely rare condition of odontogenic keratocyst. The management involves multidisciplinary approach for the rehabilitation.
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  • 文章类型: Case Reports
    背景:根性囊肿是一种牙源性病变,由根尖周炎引起的上皮残留引起,由感染或坏死牙髓的受影响牙齿顶端产生的炎症反应引起。根性囊肿的治疗管理是有争议的。只有一例病例报告通过显微外科手术和根尖切除术治疗的神经根囊肿摘除术。但是在同一外科手术中没有使用引导组织再生(GTR)技术。目前的临床病例描述了用显微外科方法治疗神经根囊肿,与实体相关的牙齿进行根尖切除术,GTR技术的应用,使用I型牛胶原蛋白的可吸收膜,和牛异种移植。
    方法:一名68岁的患者出现上外侧切牙的神经根囊肿。使用的显微外科手术治疗旨在摘除化学膜,执行牙齿的根尖切除术以及仔细和精确的逆行填充,并使用可吸收的胶原膜和牛异种移植物实施GTR技术。通过组织病理学分析证实了神经根囊肿的诊断。患者在术后10和30d进行随访评估。术后4个月评估,她仍然没有症状,X线照片显示,根尖周愈合明显,骨形成充分。
    结论:这些结果表明,使用GTR技术与胶原膜和异种移植物进行显微外科治疗,有助于骨骼再生。
    BACKGROUND: Radicular cyst is a lesion of odontogenic origin that arises from epithelial remains due to periapical periodontitis caused by inflammatory reactions generated at the apex of affected teeth with infected or necrotic pulps. The therapeutic management of radicular cysts is controversial. There is only one case report of enucleation of a radicular cyst managed with microsurgery and apicoectomy, but without the use of the guided tissue regeneration (GTR) technique in the same surgical procedure. The present clinical case describes the management of a radicular cyst with microsurgical approach, performance of an apicoectomy of the tooth associated with the entity, application of GTR technique, use of a resorbable membrane of type I bovine collagen, and bovine xenograft.
    METHODS: A 68-year-old patient presented with a radicular cyst from an upper lateral incisor. The microsurgical management used was aimed at enucleating the chemical membrane, performing apicoectomy of the tooth along with careful and precise retrograde filling, and implementing GTR technique using a resorbable collagen membrane and bovine xenograft. The diagnosis of radicular cyst was confirmed using histopathological analysis. The patient underwent follow-up evaluations at 10 and 30 d postoperatively. At 4 months postoperative evaluation, she remained asymptomatic, and radiographs showed significant periapical healing with adequate bone formation.
    CONCLUSIONS: These results suggest that microsurgical management using the GTR technique with collagen membrane and xenograft, contributes to bone regeneration.
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  • 文章类型: Case Reports
    粘液表皮样癌是一种罕见的唾液腺肿瘤,通常在女性好发的情况下观察到骨内变化,患侧更常见于下颌骨。它通常被认为是无症状的肿胀,在几个月到一年内体积增加。它们更频繁地表现为皮质膨出,并且在常规X射线照相术中作为偶然发现而被发现,是明确定义的单眼或多房性射线不透性,类似于牙源性囊肿。由于其复发或转移性质,最广泛接受的治疗是根治性手术切除。由于一名22岁的女性患者的第三磨牙受累,目前的病例在后颌中发展非常不寻常。
    Mucoepidermoid carcinoma is a rare neoplasm of the salivary gland of which the intraosseous variety is commonly observed with a female predilection and the affected side is more commonly in the mandible. It is usually perceived as an asymptomatic swelling that increases in volume over a few months to a year. They more frequently present as a cortical bulging and are mostly discovered as an accidental finding in a routine radiograph as a well-defined unilocular or multilocular radiolucency resembling an odontogenic cyst. The most widely accepted treatment is radical surgical resection due to its recurrence or metastatic nature. The current case is quite unusual developing in the posterior jaw as a result of an impacted third molar in a 22-year-old female patient.
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  • 文章类型: Case Reports
    牙龈脓肿是一种局限性的,由包括微生物斑块感染在内的各种因素引起的急性炎性病变,异物撞击,和创伤。在大多数情况下,管理包括简单的切开和引流脓性渗出物以及全身性抗生素。本文报道一例16岁女性患者,主要主诉她的右下颌前牙区域牙龈疼痛和肿胀,过去5天发烧。在第1天进行脓肿引流的紧急治疗。在审查的第五天,该病例表现出持续的牙龈炎症迹象,与43至41有关。考虑到临时诊断为牙质囊肿伴有持续性牙龈脓肿,通过经肺泡摘除受累犬和清创骨性病变进行最终治疗。病变的组织学分析显示嗜酸性凝块样区域的病灶,周围有中心和放射丝状外观,提示有牙周组织放线菌感染的发炎的牙病囊肿。
    Gingival abscess is a localized, acute inflammatory lesion which is caused by various factors that include microbial plaque infection, foreign body impaction, and trauma. Management includes a simple incision and draining of the purulent exudate along with systemic antibiotics in most of the cases. This article reports a case of a 16-year-old female patient, with a chief complaint of painful and swollen gums in her lower right front tooth region of the jaw along with fever for the past 5 days. Emergency treatment of abscess drainage was done on day 1. On 5th day of review, the case presented with persistent signs of gingival inflammation in relation to 43 to 41. Considering the provisional diagnosis as dentigerous cyst with persistent gingival abscess, definitive treatment was performed by transalveolar extraction of the impacted canine and debridement of the osseous lesion. The histologic analysis of the lesion exhibited foci of eosinophilic coagulum-like areas with epicentric and radiating filamentous appearance at the periphery, which is suggestive of an inflamed dentigerous cyst with actinomycosis infection of periodontium.
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  • 文章类型: Case Reports
    牙源性角化囊肿是牙源性起源的良性骨内病变,其特征在于其侵袭性。它通常存在于下颌后部区域,虽然它也可以在上颌骨找到,特别是在犬科地区。我们讨论了上颌窦中涉及27和28区域的OKC的独特示例。由于类似的临床症状,这种病变更容易被误认为是上颌窦的其他病变,如鼻窦炎或息肉。在另一边,这种良性疾病有可能发展为成釉细胞瘤或鳞状细胞癌。因此,良好的预后取决于早期识别,精确诊断,适当的治疗,和后续行动。
    Odontogenic keratocyst is a benign intraosseous lesion of odontogenic origin which is characterized by its aggressive nature. It is usually present in the mandibular posterior area, although it can also be found in the maxilla, particularly in the canine region. We discuss a unique example of OKC in the maxillary sinus involving the 27&28 region. Due to comparable clinical signs, this lesion is more prone to be mistaken for other lesions of the maxillary sinus, such as sinusitis or polyps. On the other side, this benign disease has the potential to develop into Ameloblastoma or squamous cell carcinoma. A favorable prognosis thus depends on early identification, precise diagnosis, appropriate treatment, and follow-ups.
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  • 文章类型: Case Reports
    描述在不使用任何矫治器的情况下,与牙质囊肿相关的未喷发前磨牙的成功喷发。
    炎性牙病囊肿是混合牙列中发生的牙病囊肿的一种变体,由于龋齿的根尖周炎症刺激了发育中的恒牙的牙釉质上皮减少,不重要的落叶前体。袋袋化是保留恒牙的首选治疗方法。
    一位10岁的患者向我们展示了一个明确的,涉及左侧下颌体的嫩肿胀,并伴有颊皮质扩张。成像后,进行有袋化,包括广泛切除覆盖该区域的肺泡粘膜以及囊性衬里。在后续行动中,注意到恒牙自发萌出成咬合。
    这表明沿波峰的有袋化可能允许相关的恒牙成功萌出并解决囊肿。
    沿波峰的有袋化提供了一种保守的选择,允许自发,在炎性牙囊肿的情况下,恒牙的无辅助萌出。必须使用仔细的术前评估来做出治疗决定。恒牙的成功萌出和疾病的总体解决都取决于充分的随访。
    JayamC,YerragudiN,KumarN,etal.有袋化治疗10岁儿童的炎症性牙囊肿:病例报告。IntJClinPediatrDent2023;16(6):871-874。
    UNASSIGNED: To describe the successful eruption of an unerupted premolar associated with a dentigerous cyst without the use of any appliances.
    UNASSIGNED: Inflammatory dentigerous cyst is a variant of dentigerous cyst occurring in the mixed dentition due to stimulation of the reduced enamel epithelium of a developing permanent tooth by periapical inflammation from its carious, nonvital deciduous precursor. Marsupialization is the preferred treatment to preserve the permanent tooth.
    UNASSIGNED: A 10-year-old patient presented to us with a well-defined, tender swelling involving the left mandibular body with buccal cortical expansion. Following imaging, marsupialization was performed involving wide excision of the alveolar mucosa overlying the region along with the cystic lining. At follow-up, spontaneous eruption of permanent teeth into occlusion was noted.
    UNASSIGNED: This suggests that marsupialization along the crest may allow for successful eruption of the associated permanent teeth with the resolution of the cyst.
    UNASSIGNED: Marsupialization along the crest provides a conservative option that allows spontaneous, unassisted eruption of permanent teeth in cases of inflammatory dentigerous cysts. Careful preoperative assessments must be used to make treatment decisions. The successful eruption of permanent teeth and the total resolution of the disease both depend on adequate follow-up.
    UNASSIGNED: Jayam C, Yerragudi N, Kumar N, et al. Inflammatory Dentigerous Cyst in a 10-year-old Child Treated by Marsupialization: A Case Report. Int J Clin Pediatr Dent 2023;16(6):871-874.
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  • 文章类型: Case Reports
    角膜成纤维细胞瘤(KA)和牙源性角膜囊肿(SOKC)的实体变体是罕见的牙源性病变,他们的关系和差异尚不清楚。本研究描述了一个病例,该病例始于牙源性角化囊肿(OKC),并在复发后转化为SOKC/KA。简而言之,一名26岁的男子出现右脸颊肿胀,被转诊至口腔颌面外科,广岛大学医院(广岛,日本)。在初次访问时,观察到单囊骨渗透从右犬延伸到磨牙,上颌窦和鼻腔。活检后,患者接受了切除手术,并被诊断为OKC.此后,该病变在13年的时间内复发了6次,并显示出与原发病变不同的组织病理学特征,全部由许多角质化囊肿组成,被诊断为SOKC/KA。Ki‑67阳性率约为10%,高于原发病变,但是没有非典型。复发性病变的遗传分析显示,腺瘤性息肉病大肠杆菌和Kirsten大鼠肉瘤病毒癌基因同源物发生突变。这个案子起源于OKC,复发时OKC和KA的形态学特征混合,支持两者之间的共同性和关联性。然而,检测到与OKC和成釉细胞瘤不同的多个突变,提示SOKC/KA与增殖活性增加和高复发率相关。
    Keratoameloblastoma (KA) and solid variant of odontogenic keratocyst (SOKC) are rare odontogenic lesions, and their relationship and differences are unclear. The present study described a case that started as an odontogenic keratocyst (OKC) and transformed to SOKC/KA upon recurrence. Briefly, a 26‑year‑old man presented with swelling in the right cheek and was referred to the Department of Oral and Maxillofacial surgery, Hiroshima University Hospital (Hiroshima, Japan). At the initial visit, unicystic bone permeation was observed extending from the right canine to the molar, maxillary sinus and nasal cavity. After the biopsy, the patient underwent excisional surgery and was diagnosed with OKC. Thereafter, the lesion recurred six times over a period of 13 years and showed different histopathological features from those of the primary lesion, all consisting of numerous cysts with keratinization, which were diagnosed as SOKC/KA. The Ki‑67 positivity rate was ~10%, which was higher than that of the primary lesion, but there was no atypia. Genetic analysis of the recurrent lesion revealed mutations in adenomatous polyposis coli and Kirsten rat sarcoma viral oncogene homolog. This case originated from OKC, and the morphological features of OKC and KA were mixed upon recurrence, supporting the commonality and association between the two. However, multiple mutations different from those of OKC and ameloblastoma were detected, suggesting an association of SOKC/KA with increased proliferative activity and a high recurrence rate.
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  • 文章类型: Case Reports
    根性囊肿是最常见的牙源性囊肿,由炎症引起。它可以变得非典型的大,尽管放射学骨质溶解的大小并不能说明病变的实体。该病例显示,患有严重自闭症的患者只能在全身麻醉下治疗,异常大的多房性根性囊肿从牙46向颊扩张。临床和放射学图片以及术中情况更能表明侵袭性囊肿或良性肿瘤。由于依从性和预后差,手术完全切除了病变,并拔除了46、47和48颗牙齿。组织病理学显示根性囊肿。术后无并发症发生。八个月后,病变几乎完全重新骨化。
    The radicular cyst is the most common odontogenic cyst and is caused by inflammation. It can become atypically large, although the size of the radiographic osteolysis says nothing about the entity of the lesion. This case shows an unusually large multilocular radicular cyst expanding buccally from tooth 46 in a patient with severe autism who can only be treated under general anesthesia. The clinical and radiological picture as well as the intraoperative situation was more indicative of an aggressive cyst or benign tumor. The lesion was surgically completely removed and the teeth 46, 47 and 48 were extracted because of poor compliance and prognosis. Histopathology revealed a radicular cyst. There were no postoperative complications. After eight months, the lesions had almost completely reossified.
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  • 文章类型: Review
    背景:痣样基底细胞癌综合征(NBCCS,Gorlin综合征)是一种罕见的常染色体显性遗传性疾病,其特征是多系统疾病,例如基底细胞癌,角化囊性牙源性肿瘤和骨骼异常。已在诊断为NBCCS的个体中报道了双侧和/或单侧卵巢纤维瘤。
    方法:一位22岁的女性,出现腰痛,盆腔超声检查发现双侧巨大附件肿块,被怀疑是恶性卵巢肿瘤。正电子发射断层扫描/计算机断层扫描显示多发颅内钙化和骨骼异常。左侧附件和右侧卵巢肿瘤经剖腹手术切除,病理提示双侧卵巢纤维瘤伴明显钙化。我们建议患者接受基因检测和皮肤病学检查。未检测到皮肤损伤。种系测试在PTCH1(Patched1)中鉴定出致病性杂合突变。
    结论:在早期诊断为卵巢纤维瘤的患者中,需要考虑NBCCS的可能性。皮肤损伤对于NBCCS的诊断是不必要的。卵巢纤维瘤通过手术切除治疗,试图保留卵巢功能。应向患者提供后续制度和未来生育选择的咨询。
    BACKGROUND: Nevoid basal cell carcinoma syndrome (NBCCS, Gorlin syndrome) is a rare autosomal dominantly inherited disorder that is characterized by multisystem disorder such as basal cell carcinomas, keratocystic odontogenic tumors and skeletal abnormalities. Bilateral and/or unilateral ovarian fibromas have been reported in individuals diagnosed with NBCCS.
    METHODS: A 22-year-old female, presented with low back pain, and was found to have bilateral giant adnexal masses on pelvic ultrasonography, which had been suspected to be malignant ovarian tumors. Positron emission tomography/computed tomography showed multiple intracranial calcification and skeletal abnormalities. The left adnexa and right ovarian tumor were resected with laparotomy, and pathology revealed bilateral ovarian fibromas with marked calcification. We recommended the patient to receive genetic testing and dermatological examination. No skin lesion was detected. Germline testing identified pathogenic heterozygous mutation in PTCH1 (Patched1).
    CONCLUSIONS: The possibility of NBCCS needs to be considered in patients with ovarian fibromas diagnosed in an early age. Skin lesions are not necessary for the diagnosis of NBCCS. Ovarian fibromas are managed with surgical excision with an attempt at preserving ovarian function. Follow-up regime and counseling on options for future fertility should be offered to patients.
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