Boyne Philip J, Hou David, Moretta Carlos, Pritchard Tyler
Department of Oral and Maxillofacial Surgery, Loma Linda University, CA 92350, USA.
J Calif Dent Assoc. 2005 Dec;33(12):961-5.
The odontogenic keratocyst, OKC, is a very aggressive intraosseos lesion with a recurrence rate of approximately 25 percent to 60 percent.' The tendency for this lesion to "return" after surgical treatment has prompted studies to obtain more information concerning the inherent nature of the lesion. The OKC lesions are usually treated with enucleation of the soft tissue lining, curettage and ostectomy of the bony margins, or with more aggressive block resection. The purpose of this study was to characterize the multifocal aspect of the OKC and to demonstrate the presence of cystic lesions remote from the margins of the primarily diagnosed cyst itself. A retrospective chart review was conducted of seven patients who had sustained a long history of recurrent OKCs. Three types of documentation were reviewed for each patient: Orthopantomograms, cephalograms, and CT scans, which had been taken over the long-term course of the disease, Detailed operation reports of surgical procedures to treat the OKC lesions, and; Large histologic specimens from the six patients who received total resection of the involved mandibular bodies. These hemimandibulectomy slides offered a unique opportunity to observe OKC activity throughout a wide osseous area. All patients hod been operated multiple times over a period of 10 to 21 years, coming eventually to mandibular resection. The operating surgeon in all of the cases was one of the authors, Philip J. Boyne, DMD, MS, DSc. All patients exhibited the multifocal nature of OKCs with demonstrable cyst formation at distant sites in the mandible. Two patients had local recurrences at the margins of the primary lesion in addition to cyst formation at distant sites. The authors concluded that clinicians should respect the multifocal nature of OKCs. The "recurrences" observed in OKCs may not necessarily be due to the degree of skill of the surgeon or the technique used to eradicate the primary cyst, but instead are probably a reflection of the multifocal nature of the pathologic lesion itself. The OKC is a very aggressive intraosseos lesion of the jaws, which not infrequently clinicians detect in the process of routine oral examination.
牙源性角化囊肿（OKC）是一种侵袭性很强的骨内病变，复发率约为25%至60%。这种病变在手术治疗后“复发”的倾向促使人们进行研究，以获取更多有关该病变内在性质的信息。OKC病变通常采用刮除软组织内衬、刮治和切除骨边缘，或更积极的整块切除进行治疗。本研究的目的是描述OKC的多灶性特征，并证明在远离最初诊断囊肿边缘的部位存在囊性病变。对7例有长期复发性OKC病史的患者进行了回顾性病历审查。对每位患者审查了三种类型的记录：在疾病的长期过程中拍摄的全景曲面断层片、头颅侧位片和CT扫描；治疗OKC病变的手术详细报告；以及6例接受受累下颌骨体全切除患者的大型组织学标本。这些半侧下颌骨切除术切片提供了一个独特的机会，可以在广阔的骨区域观察OKC的活动情况。所有患者在10至21年的时间里都接受了多次手术，最终接受了下颌骨切除术。所有病例的主刀医生都是作者之一，Philip J. Boyne，口腔医学博士、理学硕士、理学博士。所有患者均表现出OKC的多灶性特征，在下颌骨远处部位有明显的囊肿形成。除了远处部位形成囊肿外，2例患者在原发病变边缘出现局部复发。作者得出结论，临床医生应重视OKC的多灶性特征。在OKC中观察到的“复发”不一定是由于外科医生的技术水平或用于根除原发囊肿的技术，而可能是病理病变本身多灶性特征的反映。OKC是颌骨一种侵袭性很强的骨内病变，临床医生在常规口腔检查过程中经常会检测到。
