Harazono Yosuke, Thai Huy Thanh, Vu Duc Viet, Takahara Namiaki, Yoda Tetsuya
Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.
Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Viet Nam.
Int J Surg Case Rep. 2024 Oct;123:110156. doi: 10.1016/j.ijscr.2024.110156. Epub 2024 Aug 16.
Marsupialization is a dependable choice for mandibular unicystic ameloblastoma (UA) management. However, investigations regarding its speed of shrinkage (SS) and reduction rate (RR) are lacking. This case report highlights the treatment of a huge mandibular UA with high SS and RR using marsupialization before secondary surgery.
A 45-year-old male patient presented with severe swelling of the right side of the mandible, resulting in prominent facial asymmetry. Panoramic radiograph revealed a unilocular, radiolucent lesion extending from the mandibular midline to the right ramus. Computed tomography (CT) revealed a large radiolucent lesion that expanded in the buccolingual direction. Incisional biopsy showed that the lesion was UA. After 1.5 years of marsupialization, an SS of 0.183 % per day was reached, leading to an impressive RR of 98.7 %. Treatment was followed by enucleation and peripheral osteotomy. No recurrence was observed at 1 year post-surgery.
The treatment of mandibular UA remains controversial, ranging from conservative approaches to aggressive interventions. In the current case, marsupialization was highly effective in reducing the volume of the lesion, thereby facilitating a minimally invasive secondary surgery to preserve function. The intact periosteum, which has the potential to differentiate into various cell types, may be associated with the regeneration of new bone after marsupialization.
Marsupialization remains a successful strategy for managing mandibular UA. Even the huge lesions causing facial deformity can be treated with marsupialization combined with secondary surgery, avoiding the aesthetic and functional disruptions associated with radical treatment.
袋形术是治疗下颌单囊性成釉细胞瘤（UA）的可靠选择。然而，目前缺乏关于其缩小速度（SS）和缩小率（RR）的研究。本病例报告重点介绍了在二次手术前采用袋形术治疗一例具有高SS和RR的巨大下颌UA的情况。
一名45岁男性患者，下颌右侧严重肿胀，导致面部明显不对称。全景X线片显示一个单房性透射性病变，从下颌中线延伸至右下颌支。计算机断层扫描（CT）显示一个大的透射性病变，在颊舌方向扩展。切开活检显示病变为UA。袋形术后1.5年，达到了每天0.183%的SS，RR高达98.7%。治疗后进行了刮除术和周边截骨术。术后1年未观察到复发。
下颌UA的治疗仍存在争议，从保守方法到积极干预不等。在本病例中，袋形术在减少病变体积方面非常有效，从而便于进行微创二次手术以保留功能。完整的骨膜有可能分化为各种细胞类型，这可能与袋形术后新骨的再生有关。
袋形术仍然是治疗下颌UA的成功策略。即使是导致面部畸形的巨大病变，也可以通过袋形术联合二次手术进行治疗，避免了根治性治疗带来的美学和功能破坏。
