Kalantar Motamedi M H
Clinic of Oral and Maxillofacial Surgery, Baqiyatallah Medical Center, Iran.
J Craniomaxillofac Surg. 1998 Feb;26(1):56-62. doi: 10.1016/s1010-5182(98)80036-x.
This article re-evaluates the various clinicopathological presentations and array of radiographic features displayed by aneurysmal bone cysts (ABCs) of the jaws. In this retrospective clinical study, 17 cases of ABCs of the jaws surgically treated during an 11-year period from 1986-1997 are evaluated. The age and sex distribution, diagnostic characteristics, mode of treatment and long-term surgical results are presented and compared with the international literature. Investigation included serial clinical examinations, appropriate radiographic evaluation, CT scans and angiograms when indicated. All the patients had mandibular lesions and were managed by complete surgical curettage of the lesions. Ten were in males (58.8%) and seven (41.2%) in females. The mean age of occurrence was 21.05 years, ranging from 7 to 58 years. Clinical presentation in these patients ranged from an asymptomatic incidental radiographic finding to an expanding, rapidly progressive and destructive lesion resulting in a pathological fracture. Radiographic findings varied from unicystic radiolucencies or moth-eaten radiolucencies to extensive multilocular lesions causing bilateral expansion and destruction of the mandibular cortices. Twelve of the patients (70.5%) could recall a history of trauma. Needle aspiration with a 16 or 18 guage needle was positive, producing syringes full of blood in all but two of the cases (88.2%). Six cases (35.2%) were extremely vascular and had increased rapidly in size, and three required angiographic studies for preoperative diagnosis and differentiation from other vascular entities. Nine of the cases (52.9%) were found in the mandibular angle-ramus area. Four cases (23.5%) required extraoral surgical access for curettage while the remainder were treated intraorally. During the follow-up period, which ranged from 2-11 years, no recurrences have occurred. Restoration of facial symmetry and bone formation has been favourable in all patients, despite the fact that grafts were not used. This 11-year study shows that ABCs present with varied clinicopathological and radiographic features and thus may pose a diagnostic dilemma. As we have not noted any recurrences following surgical curettage of mandibular lesions, we feel that initial surgical resection or bone grafting is not necessary, provided that adequate access and complete curettage can be obtained.
本文重新评估了颌骨动脉瘤样骨囊肿（ABCs）的各种临床病理表现及一系列影像学特征。在这项回顾性临床研究中，对1986年至1997年11年间手术治疗的17例颌骨ABCs病例进行了评估。呈现了年龄和性别分布、诊断特征、治疗方式及长期手术结果，并与国际文献进行了比较。调查包括系列临床检查、必要时进行的适当影像学评估、CT扫描及血管造影。所有患者均有下颌骨病变，均通过病变的完全手术刮除进行治疗。男性10例（58.8%），女性7例（41.2%）。发病的平均年龄为21.05岁，范围为7至58岁。这些患者的临床表现从无症状的偶然影像学发现到导致病理性骨折的扩展性、快速进展性和破坏性病变不等。影像学表现从单房性透射区或虫蚀状透射区到导致下颌骨皮质双侧扩展和破坏的广泛多房性病变各不相同。12例患者（70.5%）可回忆起外伤史。用16或18号针进行针吸检查呈阳性，除2例（88.2%）外，其余病例注射器中均充满血液。6例（35.2%）血管极其丰富，且体积迅速增大，3例需要进行血管造影检查以进行术前诊断并与其他血管性病变相鉴别。9例（52.9%）病例位于下颌角-升支区域。4例（23.5%）需要口外手术入路进行刮除，其余病例采用口内治疗。在2至11年的随访期内，未发生复发。尽管未使用移植骨，但所有患者面部对称性的恢复及骨形成情况良好。这项为期11年的研究表明，ABCs具有多样的临床病理和影像学特征，因此可能造成诊断上的困境。由于我们未注意到下颌骨病变手术刮除后有任何复发情况，我们认为只要能获得足够的手术入路并进行彻底刮除，初始手术切除或植骨并非必要。
