Fidele Nyimi Bushabu, Bing Liu, Sun Yanfang, Wu Tianfu, Zheng Yueyu, Zhao Yifang
Department of Oral Maxillofacial Head and Neck Oncology Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei 430079, P.R. China.
The State Key Laboratory Breeding Base of Basic Science of Stomatology, and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei 430079, P.R. China.
Oncol Lett. 2019 Jul;18(1):733-741. doi: 10.3892/ol.2019.10367. Epub 2019 May 17.
The present study reported the clinical outcomes of 35 patients with mandibular odontogenic keratocysts (OKCs) following treatment by radical resection and immediate defect reconstruction. Amongst 565 patients with OKCs that were treated between April 2003 and May 2015, 35 patients underwent segmental or marginal mandibulectomy. The use of radical resection was based on clinical and/or radiographic evidence of size, cortical perforation and subsequent soft tissue involvement, and on the history of previous recurrence of the same lesion. Recurrence, justifications of the main major factor for resection, and functional and cosmetic results of the patients following mandibular reconstruction were systematically evaluated. There were 26 OKCs in the mandibular molar-ramus region, eight in the mandibular anterior-premolar region and one in the mandibular molar-ramus and anterior-molar regions. Among the 35 patients, 20 had primary OKCs and 15 had recurrent OKCs. A total of 31 patients underwent segmental mandibulectomy, of which 28 were immediately reconstructed with a vascularized flap, whereas four patients underwent marginal mandibulectomy. The functional and cosmetic outcomes of patients were evaluated as satisfactory. The length of the follow-up period ranged from 2 to 17 years following operation (average, 5.82 years). Recurrence was identified in one patient who had been treated with marginal mandibulectomy. In conclusion, the findings from the present study suggested that radical resection may be recommended for patients with OKCs and locally aggressive features. Immediate mandibular reconstruction with a vascularized flap may be a crucial part of this aggressive treatment method that may reduce OKCs-associated morbidity.
本研究报告了35例下颌牙源性角化囊肿（OKC）患者在接受根治性切除及即刻缺损重建治疗后的临床结果。在2003年4月至2015年5月期间接受治疗的565例OKC患者中，35例接受了下颌骨节段性或边缘性切除术。根治性切除的应用基于囊肿大小、皮质穿孔及随后的软组织受累情况的临床和/或影像学证据，以及同一病变既往复发史。系统评估了复发情况、切除的主要主要因素的理由以及下颌骨重建后患者的功能和美容效果。下颌磨牙-升支区域有26例OKC，下颌前磨牙区域有8例，下颌磨牙-升支和前磨牙区域有1例。35例患者中，20例为原发性OKC，15例为复发性OKC。共有31例患者接受了下颌骨节段性切除术，其中28例立即用带血管蒂皮瓣重建，4例患者接受了下颌骨边缘性切除术。患者的功能和美容效果评估为满意。术后随访时间为2至17年（平均5.82年）。1例接受下颌骨边缘性切除术的患者出现复发。总之，本研究结果表明，对于具有局部侵袭性特征的OKC患者，可能推荐根治性切除。用带血管蒂皮瓣即刻进行下颌骨重建可能是这种积极治疗方法的关键部分，可降低与OKC相关的发病率。
