颌骨囊肿的回顾性研究汇总

1、crnfsmjrclin oral investdoi 10.1007/s00784-015-1552-yreviewlong-term results after treatment of the jaws: a reviewof extensive odontogenic cystsrobert wakolbinger 1 & johann beck-mannagetta 2received: 27 april 2015/accepted: 27 july 2015# springer-verlag berlin heidelberg 2015abstractaim the aim was

2、 to perform a literature review concerning long-term resultsafter treatment of extensivecysts of the jaws. methods the following databaseswere searched:medline, cochrane central, cochrane databaseof systematic reviews, the cochrane library, and embase. case reports and abstractswere excluded.results

3、 three hundred fifty-six articles were found, of which 30 were included. only the minority of the studies reported long-term results. most authors did not distinguish between temporary complications and permanent deficiencies (incomplete bone healing, permanent sensory deficits).conclusion based on

4、this review, it is recommended to consider primary decompression or marsupialization later definitive surgery for the treatment of extensive jaw cysts in order to achieve satisfying clinical results.clinical relevance complications (occurring within the first 6 months postoperatively, e.g., infectio

5、n) and remaining deficits (after a minimum of 6 months andnot changing over time, e.g., bony or sensorydeficit) should be clearly separatedfrom each other. knowledge of permanent deficits and bone healing after different therapeuticapproachesis important for decision making. patientsshould be inform

6、ed not only about complications but also about the risk of permanent deficits for eachmethod.keywords jaw cysts . treatment. complications . long-term results . reviewintroductionmore than 100 years have passed since the first publications on the surgical approachto jaw cysts appearedin the german l

7、iterature 1,2. although today the treatment of small cysts (radiologic diameter less than 1.5 cm) is rarely problematic, the approach to larger cysts still remains controversial: while some authors recommend to enucleate even large cysts 3, others prefer decompression or marsupialization 4.only few

8、studies deal with the long-term results after surgical cyst therapy. in addition, most authors do not clearly distinguish between postoperative complications (e.g., infection) and permanent deficits (that are loss of sensitivity and/or incomplete ossification). for these reasons, it seemed desirable

9、 to carry out a review of the literature with special regard to the long-term results after the treatment of extensive cysts of the jaws.methodsrobert wmedical university of vienna, vienna, austriaparacelsusmedical university, salzburg, austriaan extensive litera

10、ture review using the following databases was conducted (table 1): pubmed interface of medline, cochrane central register of controlled trials, cochrane databaseof systematic reviews (cdsr), the cochrane library, and embase (searcheswere last conducted on april 5, 2014). references were checked as w

11、ell.inclusion criteria were full articles, at least caseseries(sin- gle case reports or abstractswere excluded), follow-up examination as well as language (english or german). nonrelevant articles were excluded.0 sprinjfrpublished online: 08 august 2015clin oral investtable 1 search terms used for t

12、he respectivedatabasespubmedkeywords: bjaw cyst long term,a baw marsupialization long term/ baw cystostomy long term,a baw decompressionlong term,a baw cystectomy long term/ bjaw cyst enucleationlong term,a baw cyst sensitivity,a baw cyst hypoesthesiacochrane centralcochrane databaseof systematic re

13、views(cdsr)the cochranelibraryembaseheading baw cystakeyword bjaw cystakeyword baw cystaheadings bjaw cystj bodontogenic keratocysf鱼 springerif an article was found by more than one search terms, it was assignedonly to the first one.parameters/key pointsall included articles were reviewed for the fo

14、llowing key points: the articles main topic, number of cysts analyzed, mean cyst diameter, surgical method(s) used, mean followup period, and long-term deficits mentioned.clarification of termsthe authors defined blong-term deficita aspermanent sensory deficits (that is impaired sensitivity of teeth

15、 or the skin area next to the mental foramen) and/or incomplete bone healing, regardlessof the defect size.resultsin total, 356 articles were found, of which 30 were included (table 2). table 3 and fig. 1 give an overview on articles reporting long-term results after treatment of jaw cysts, accordin

16、g to the parametersmentioned above. articles covering only keratocysts were listed separately (table 4).table 2 number of articles found and included, for each databasedatabasearticles foundarticles includedpubmed22816cochrane central80cdsr00cochrane library10embase1193by referencesn/a11total35630di

17、scussioncysts of the jaws are pathologic cavities within the bone of the maxilla or the mandible, lined by odontogenic epithelium (odontogenic cysts) 57.diagnosiscystic cavities enlarge overtime, tend to expand and weaken thebone, and endangerthe vitality of neighboring teeth.com- plications can occ

18、ur, such asinfection, mandibular fracture, or encroachment upon the maxillary sinus or the nasal cavity. possible signs areswelling with or without pain and loosening or displacement of teeth 8 10.radiographically, the orthopantomogram renders a summation of teeth, bone, temporomandibular joint, and

19、 the inferior part of the nose and the maxillary sinus. in this imaging modality, cysts of the jaws appearas sharply delineated radio- lucencies. in the case of infection, the margin can appear blurred 7, 8. modern techniques, such as computed tomography (ct), magnetic resonance imaging (mri), or co

20、ne beam ct, can sometimes yield additional information about the cysts size and relationship to endangered structures. therefore, ct is an established technique, even though it brings about a higher radiation dose 11 13. of course, ct and cone beam ct were not available in the older publications.man

21、agementpatientssuffering from cysts of the jaws should undergo surgery 5, 14. there are mainly two different procedures:(a) enucleation (bcystectomyj i.e., complete removal of the cyst lining and primary closure of the wound 2, 5) or(b) two different forms of bcystostomya ：marsupialization, that is

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29、 cnoyact5 e uu+as c&xzxnii- e-gli oeq_icanco-ax- ccasezsaw6uaxb-tow j cqitxilq-eocxdqotj-arn_xnzoq-qgb cliu nj(dqe=5n(d sunczwoqh-cu-xxd e_cud i m egnxu 6-auiom_(do-q o d tip esc/mu-to ch co(u,edg*瓯.sjds afig. 1 graphical overview on literature concerning four parameters(radiologic cyst size, surgic

30、al method, follow-up period, and permanent hypoesthesia):articles were categorized according the information providedgraphical overview (relevant informa?on that was provided in literature)100%parametersinforma?on providedmore than one method_ decompression/marsupializa?on (cystostomy) enuclea?on (c

31、ystectomy)imprecise informa?on not givendecompression is similar to marsupialization but uses a smaller incision and in many cases,a hollow stent is inserted 1,4,15.in every case,the cyst lining should be examined histopath- ologically. in case of complete enucleation (cystectomy), the entire specim

32、en can be examined. by marsupialization (cystostomy), however, only a rather small part of the cyst lining (of the area necessary for the wide opening) can be examined. in rare cases,the synchronous occurrence of cancer or ameloblastoma in an odontogenic cyst has been reported 16. if the diagnosis o

33、f a cyst is questionable, a pretreatment biopsy is indicated. in some cases,it may be helpful to take a sample of the cyst content (by puncture or lavage) 17.both surgical methods have their specific advantagesand disadvantages:enucleation is a fast and effective method for complete removal of the c

34、yst lining once the wound has healed (10 14 days), there is no need for special hygiene measures or regular follow-up visits. in larger cysts, antibiotics may be recommended. infection and wound dehiscence can occur and can necessitateirrigation until secondary wound healing is completed 10.marsupia

35、lization and decompression are minor interventions they are performed to preserve adjacentstructures (inferior alveolar nerve, vital teeth) until sufficient ossification has taken place. they may be appropriate in elderly personsor in patients with compromised wound healing, such as diabetics. moreo

36、ver, there is no need for antibiotics 15. if necessary, secondary definitive surgery (usually enucleation, btwo-stage treatment) can be performed after the decompression period, which can take more than 1 year. however, marsupialization and decompression require regular follow-up visits and irrigati

37、on of the cyst cavity as well as repeated adjustment of the obturator or the stent. moreover, only a small part of the cyst lining can be examined histologically 10.even though previous work encouraged surgeons to use bone grafts for filling large defects after enucleation in order to prevent pathol

38、ogic fractures 18 n0, wakolbinger and beck-mannagetta were able to demonstrate uncomplicated healing after enucleation of large cysts without osteoplasty by autologous boneor bone substitutes10. this is supported by other authors3,14, 21 23. therefore, it canbe concluded that the complex procedure o

39、f osteoplasty is rarely necessary in most casesof extensive defects after enucleation.large cysts of the upper jaw arelikely to encroach upon the maxillary sinus, the palate, or the nasal cavity, leading easily to resorption of the more cancellous bone of the maxilla. extensive cystsof the posterior

40、 maxilla can be enucleatedtogeth- er with the overlying antral mucosa (bantrocystectomya). in this way, the maxillary sinus is extended and the wound surface will heal spontaneously. large cysts in the anterior max- 川a with resorption of the nasal floor can bemarsupialized to the nasal cavity (brhin

41、ocystostomy) 24.in the more compact mandible, extensive cysts will lead to a swelling and need more time until bone resorption occurs. the decision for cystectomy or cystostomy does not depend on the localization (maxilla or mandible) but on the existence of viable bony walls and periosteum at the p

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50、esultsbecause the treatment of large cysts of the jaws can be difficult, recommendations arecontroversial. most authors do not compare their therapy with anothertreatment modality. therefore, the number of high-quality controlled studies is low. moreover, the majority of publications do not provide

51、sufficient long-term results.nearly all authors make no difference between temporary complications and long-term deficits. blong-term deficita should only mean permanentsensory deficits (that is, impaired sensitivity of teeth or the skin areanext to the mental foramen) or incomplete bone healing, re

52、gardlessof the defect size 10.publications regarding the cysts sizefenner and colleagues25 found no correlation of radiologic diameter and tooth sensitivity or mobility. unfortunately, they did not investigate bone healing.wakolbinger and beck-mannagetta 10 reported permanent sensory disturbances of

53、 the skin area next to the mental foramen in 7% of smaller and in 5 % of largercysts. moreover, desensitizationof teeth was found in 25 % of smaller and 23 % of larger cysts (the frequency of primary decompressionwas higher in largercysts). incomplete bone healing was found in 10 % of largercysts but not in smaller cysts. overall, therewas uncomplicated healing in 68 % of cysts less than 2 cm radiologic diameter and in 65 % of cysts of 2 cm and more.publications regarding the treatment methodakay et al. 26 reported successful healing after marsupialization of