Goto Mitsuo, Ueda Sei, Miyabe Satoru, Watanabe Satoshi, Sugita Yoshihiko, Nagao Toru
Department of Maxillofacial Surgery, Aichi Gakuin University, School of Dentistry, 2-11 Suemori-dori Chikusa-ku, Nagoya 464-8651, Japan.
Department of Maxillofacial Surgery, Aichi Gakuin University, School of Dentistry, 2-11 Suemori-dori Chikusa-ku, Nagoya 464-8651, Japan.
Int J Surg Case Rep. 2020;71:132-138. doi: 10.1016/j.ijscr.2020.05.003. Epub 2020 May 21.
Odontogenic keratocyst (OKC) is the third most common odontogenic cyst which arises from cell rests of dental lamina, and usually observed in the jaws. Because OKC is noted for its high rate of recurrence, there are various treatment strategies. Here, we present a rare case of OKC which occupied the entire maxillary sinus and pterygoid process of the sphenoid bone extending nearly to the skull base.
The patient was a 21-year-old male and underwent surgical removal of the cyst using the Caldwell-Luc procedure which in this case extended the surgical approach to the pterygoid process of the sphenoid bone via the pterygomaxillary junction. However, we found a recurrent lesion in the posterior wall of the maxillary sinus 20 months after the surgery and subsequently performed a secondary cystectomy. Surgical specimens showed positive bcl-2 staining of OKC and negative cytokeratin-10 on immunohistochemistry for both primary and recurrent lesions.
OKC rarely occurs in the maxillary sinus and extends to the deep maxillary structure and the skull base. In order to prevent recurrence, it is necessary to recognize the exact location of the entire lesion. Careful examination of preoperative CT images is needed to make a complete surgical planning and to perform a reliable surgical procedure.
牙源性角化囊肿（OKC）是第三常见的牙源性囊肿，起源于牙板的细胞残余，通常发生于颌骨。由于OKC以其高复发率而闻名，因此有多种治疗策略。在此，我们报告一例罕见的OKC病例，该囊肿占据了整个上颌窦和蝶骨翼突，几乎延伸至颅底。
患者为一名21岁男性，采用柯-陆氏手术（Caldwell-Luc procedure）切除囊肿，在此病例中，手术入路经翼上颌裂扩展至蝶骨翼突。然而，术后20个月我们在上颌窦后壁发现了复发病变，随后进行了二次囊肿切除术。手术标本免疫组织化学显示，原发性和复发性病变的OKC均为bcl-2染色阳性，细胞角蛋白-10染色阴性。
OKC很少发生于上颌窦并延伸至深部上颌结构和颅底。为防止复发，有必要明确整个病变的确切位置。需要仔细检查术前CT图像以制定完整的手术计划并实施可靠的手术操作。
