Schmid Ivan, Grätz Klaus W, Locher Michael C
Klinik für Mund-, Kiefer- und Gesichtschirurgie, Poliklinik für Orale Chirurgie, Zentrum für Zahnmedizin der Universität Zürich, Zürich, Switzerland.
Schweiz Monatsschr Zahnmed. 2012;122(5):403-23.
Keratocystic odontogenic tumours (KCOT) are benign neoplasia of dentogenic origin and have a high relapse rate. Various invasive treatment methods (decompression, marsupialisation, enucleation, enucleation with adjunctive therapy such as scraping out of the bone cavity, Carnoy's solution or cryotherapy, mandibular resection) have been described for the treatment of KCOT. There is no common opinion on the best kind of treatment. Most of the articles in the literature report on a follow-up period of 5-7 years, but relapses have been described even after longer periods of time. This article presents 3 cases with late relapses that were treated at the University of Zurich, Center of Dental Medicine, Clinic of Cranio-Maxillofacial Surgery and Clinic for Oral Surgery. At the time of the initial diagnosis, the patients were 19, 24.5 and 36 years old. In all 3 patients the KCOT was localized in the angulus/ramus mandibula and an impacted wisdom tooth was present in the affected area. Case no. 1 was treated solely by marsupialisation of the KCOT. In cases no. 2 and 3, the cystic lesion was first marsupialised and later treated by enucleation and application of Carnoy's solution. In case no. 1, a relapse developed 13.5 years after the first operation. In case no. 2, relapses occurred 9, 28 and 31 years after the first operation. In case no. 3, a first relapse appeared 9 years and a second one 18 years after the first operation.
Patients with a KCOT require lifelong aftercare because relapses of KCOTs can arise even after 10 or more years. The aftercare concept at the University of Zurich, Center of Dental Medicine, Clinic of Cranio-Maxillofacial Surgery and Clinic for Oral Surgery therefore consists of a clinical and x-ray (orthopantomogram) follow-up examination every year for the first 10 years and every two years thereafter.
牙源性角化囊性瘤（KCOT）是牙源性良性肿瘤，复发率高。已描述了多种侵入性治疗方法（减压、袋形缝合术、摘除术、辅以骨腔刮除、卡诺氏液或冷冻疗法等辅助治疗的摘除术、下颌骨切除术）用于治疗KCOT。对于最佳治疗方式尚无共识。文献中的大多数文章报道的随访期为5至7年，但即使在更长时间后仍有复发的描述。本文介绍了苏黎世大学牙医学中心、颅颌面外科诊所和口腔外科诊所治疗的3例晚期复发病例。初诊时，患者年龄分别为19岁、24.5岁和36岁。所有3例患者的KCOT均位于下颌角/升支，且患区存在一颗阻生智齿。病例1仅通过KCOT袋形缝合术治疗。病例2和病例3中，囊性病变首先进行袋形缝合术，随后通过摘除术和应用卡诺氏液治疗。病例1在首次手术后13.5年复发。病例2在首次手术后9年、28年和31年复发。病例3在首次手术后9年首次复发，18年第二次复发。
KCOT患者需要终身随访，因为即使在10年或更长时间后仍可能出现KCOT复发。因此，苏黎世大学牙医学中心、颅颌面外科诊所和口腔外科诊所的随访方案包括在最初10年每年进行临床和X线（全景片）随访检查，此后每两年进行一次。
