Covello Paul, Buchbinder Daniel
Division of Maxillofacial Surgery, Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
Curr Opin Otolaryngol Head Neck Surg. 2016 Aug;24(4):343-51. doi: 10.1097/MOO.0000000000000269.
The management of benign, locally aggressive odontogenic tumors, namely, keratocystic odontogenic tumors (KOTs) and ameloblastomas, can be challenging. The purpose of this article is to briefly summarize important features of these lesions and review recent trends in the literature regarding their treatment.
Currently, KOTs are frequently treated with a conservative approach consisting of enucleation and adjuvant decompression or local microablation with peripheral ostectomies, Carnoy's solution, or cryotherapy. Conversely, ameloblastomas generally require marginal or segmental resection followed by reconstruction using local bone regeneration techniques or vascularized osteocutaneous free flaps, respectively. Bone regeneration techniques have improved with the use of autogenous progenitor cells held in place by autogenous or alloplastic scaffolding. Esthetic results for free flap reconstruction have improved with the use of inconspicuous surgical approaches utilizing intraoral or rhytidectomy incisions. Molecular markers for both neoplasms are being investigated as potential targets for chemotherapeutic agents.
Excluding hamartomas (i.e., odontomas), KOTs and ameloblastomas are the most common benign odontogenic lesions. Their management is often complicated by their locally infiltrative behavior, responsible for high rates of recurrence. Simple enucleation or excision of these lesions has proven insufficient. When left untreated, these lesions are capable of causing severe disfigurement and loss of function. Knowledge regarding current best practices and potential future therapeutics is imperative to well treated and effective disease management.
良性、局部侵袭性牙源性肿瘤，即角化囊性牙源性肿瘤（KOTs）和成釉细胞瘤的治疗具有挑战性。本文旨在简要总结这些病变的重要特征，并回顾文献中关于其治疗的最新趋势。
目前，KOTs常采用保守方法治疗，包括摘除术及辅助减压或采用周边截骨术、卡诺氏液或冷冻疗法进行局部微消融。相反，成釉细胞瘤通常需要边缘性或节段性切除，随后分别采用局部骨再生技术或带血管蒂游离骨皮瓣进行重建。通过使用自体或异体支架固定的自体祖细胞，骨再生技术有所改进。通过采用口腔内或除皱切口等不显眼的手术方法，游离皮瓣重建的美学效果得到了改善。这两种肿瘤的分子标记物正在作为化疗药物的潜在靶点进行研究。
除错构瘤（即牙瘤）外，KOTs和成釉细胞瘤是最常见的良性牙源性病变。它们的局部浸润行为常导致治疗复杂化，复发率高。事实证明，简单地摘除或切除这些病变是不够的。如果不进行治疗，这些病变会导致严重的毁容和功能丧失。了解当前的最佳治疗方法和潜在的未来治疗手段对于良好治疗和有效管理疾病至关重要。
