Stoelinga P J
Department of Oral and Maxillofacial Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
Int J Oral Maxillofac Surg. 2001 Feb;30(1):14-25. doi: 10.1054/ijom.2000.0027.
A prospective study was conducted on 82 odontogenic keratocysts (OKCs) diagnosed in 80 patients over a 25 year period. The clinical and radiographic data were correlated, which resulted in an accurate picture of the clinical presentation, relationship with teeth and incidence of lingual perforations in mandibular OKCs. In 40% of the cysts no suspicion had arisen before surgery, in 60% the diagnosis was secured before surgery. This last group of patients was treated according to a defined protocol, with the exception of the maxillary OKCs, which entailed excision of the attached, overlying mucosa and enucleation of the cyst after which the defect was treated with Carnoy's solution. The other patients underwent just enucleation of the cysts. For the first 5 years the patients were seen every year, thereafter every 2 years if possible. Recurrences (9/82) were mainly found in the patients in which the cyst had just been enucleated. Only three cysts recurred in the group treated according to the above mentioned protocol. Most recurrences presented within 5 years, but late recurrences did occur even after 25 years. The aetiology and pathogenesis of OKCs is briefly discussed in the light of the present findings. It is concluded that the suggested treatment protocol and follow-up schedule provides a safe means to manage a lesion that is known to recur and may even give rise to life threatening situations.
在25年期间，对80例患者诊断出的82个牙源性角化囊肿（OKC）进行了一项前瞻性研究。对临床和影像学数据进行了关联分析，从而准确了解了临床表现、与牙齿的关系以及下颌OKC舌侧穿孔的发生率。40%的囊肿在手术前未被怀疑，60%的囊肿在手术前确诊。除上颌OKC外，后一组患者按照既定方案进行治疗，上颌OKC需切除附着的覆盖黏膜并摘除囊肿，然后用卡诺氏液处理缺损。其他患者仅进行囊肿摘除。最初5年每年对患者进行检查，此后尽可能每2年检查一次。复发（9/82）主要发生在仅摘除囊肿的患者中。按照上述方案治疗的组中仅3个囊肿复发。大多数复发发生在5年内，但即使在25年后也确实出现了晚期复发。根据目前的研究结果简要讨论了OKC的病因和发病机制。得出的结论是，建议的治疗方案和随访计划为处理已知会复发甚至可能导致危及生命情况的病变提供了一种安全方法。
