下颌角大型复杂牙瘤——口内剜除术作为下颌骨连续性切除术的替代方法。
Large Complex Odontoma in the Angulus Mandibulae - Intraoral Enucleation as an Alternative to Mandibular Continuity Resection.
机构信息
Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Hamburg, Germany;
Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Hamburg, Germany.
出版信息
In Vivo. 2024 Sep-Oct;38(5):2535-2539. doi: 10.21873/invivo.13726.
BACKGROUND
Odontomas are among the most common odontogenic tumors and are generally considered as hamartomatous odontogenic lesions. These tumors can be histopathologically divided into complex odontomas and compound odontomas based on their composition. Odontomas show a slow growing behavior and typically lack characteristic symptoms. The standard surgical treatment for large odontogenic tumors is a mandibular (continuity) resection followed by primary or secondary plastic reconstruction.
CASE REPORT
A 22-year-old male presented to the Department of maxillofacial surgery with an increasing feeling of pressure in the left mandible. An orthopantomogram revealed a large complex odontoma rg 038. Instead of mandible continuity resection an alternative minimally invasive technique/approach (intraoral) with a trapezoidal bone flap for the enucleation of an odontoma of the mandibular angle with subsequent flap reimplantation and osteosynthesis was performed.
CONCLUSION
Surgical enucleation of large mandibular odontoma with a continuity resection through an extraoral approach represents the surgical standard treatment of this entity. The present case report describes an alternative minimally invasive technique/approach. This technique may reduce surgical risks of the continuity resection through an extraoral approach (nerve damage, scarring) and can improve the long-term stability of the mandible by bone preservation.
背景
牙瘤是最常见的牙源性肿瘤之一，通常被认为是牙源性错构瘤病变。这些肿瘤可以根据其组成在组织病理学上分为复杂牙瘤和组合牙瘤。牙瘤生长缓慢，通常缺乏特征性症状。大型牙源性肿瘤的标准手术治疗是下颌骨（连续性）切除术，然后进行原发性或继发性整形重建。
病例报告
一名 22 岁男性因左下颌不断增大的压迫感到颌面外科就诊。全景片显示一个大型复杂牙瘤 rg038。我们选择了一种替代的微创技术/方法（口内），通过梯形骨瓣进行下颌角牙瘤的剜除，然后进行皮瓣再植入和骨合成，而不是进行下颌骨连续性切除术。
结论
通过口腔外入路的连续性切除术对大型下颌骨牙瘤进行外科剜除是该疾病的标准手术治疗方法。本病例报告描述了一种替代的微创技术/方法。这种技术可以降低口腔外入路连续性切除术的手术风险（神经损伤、瘢痕形成），并通过保存骨量来提高下颌骨的长期稳定性。
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