• 沒有找到結果。

原文題目

N/A
N/A
Protected

Academic year: 2022

Share "原文題目"

Copied!
5
0
0

加載中.... (立即查看全文)

全文

(1)

原文題目(出處): Multifocal traumatic bone cysts: Case report and current thoughts on etiology. J Oral Maxillofac Surg 2010;68:208-12.

原文作者姓名: Kuhmichel A, Bouloux G

通訊作者學校: Department of Oral and Maxillofacial Surgery, The Emory Clinic,1365B Clifton Rd NE, Suite 2300, Atlanta, GA, USA 報告者姓名(組別): 方子榮 (G組)

報告日期: 99.04.13

內文:

Introduction

1. The term traumatic bone cyst has been recognized as a misnomer in that the incidence of prior trauma in patients with this entity is the same as in the general population.

2. A variety of other terms have been used by different authors to describe the traumatic bone cyst: solitary bone cyst, simple bone cyst, hemorrhagic bone cyst, progressive bone cyst, idiopathic bone cyst, and unicameral bone cyst.

3. Several hypotheses for the pathogenesis of this lesion:

(A)Cohen: the cyst develops because of a lack of collateral lymphatic drainage of venous sinusoids. This apparent blockage then results in the entrapment of interstitial fluid causing resorption of the bony trabeculae and cyst development.

(B)Mirra et al: traumatic bone cysts are synovial cysts, developing as a result of a developmental anomaly whereby synovial tissue is incorporated intraosseously.

4. Traumatic bone cysts are typically found as solitary lesions.

 multiple synchronous lesions were reported to occur in about 11% of cases.

Repot of a case Present illness:

A 32-year-old white woman saw her general dentist for a routine annual visit when a large radiolucency of the left mandibular body was noted on her panoramic radiograph. Endodontic treatment of the lower left first molar tooth was begun for a presumed diagnosis of a radicular cyst. There was no change in the size of the lesion over the following 6-month period, and she was referred to the Department of Oral and Maxillofacial Surgery, Emory University (Atlanta, GA).

Past medical history:

a right cerebrovascular accident 8 years earlier that resulted in right-sided deafness and hypoesthesia of all divisions of the right trigeminal nerve;

recalled no history of trauma.

seasonal allergies for which she periodically took antihistamine medication.

Personal habit:

occasional alcohol use but denied any use of tobacco products.

Clinical examination:

unremarkable with no evidence of lymphadenopathy, swelling, or asymmetry.

Intraoral examination:

no soft tissue abnormality or bony expansion;

the periodontium: healthy with no evidence of gingivitis, periodontal pocketing, or tooth mobility;

no carious lesions.

all teeth is vital except the lower left first molar panoramic radiograph:

a scalloped unilocular radiolucency in the left body area and multiple unilocular

(2)

periapical radiolucencies in the mandibular symphyseal region

computed tomography scanning:

a unicystic lesion within the left mandibular body and multiple unicystic lesions within the mandibular symphysis

Impression:

The symphyseal lesions were thought to most likely be periapical cemental dysplasia.

The left mandibular lesion was thought to be a traumatic bone cyst, radicular cyst, keratocyst, or unicystic ameloblastoma.

(3)

Before surgery:

endodontic treatment was completed; a complete blood count and serum electrolyte levels, including calcium, were assessed; all indices were within normal limits.

Treatment plan:

Excisional biopsy of the left mandibular body lesion with apicoectomy and retrograde filling of the lower left first molar. An excisional biopsy of one of the symphyseal lesions was also proposed.

Surgical procedure:

1.under general anesthesia, both lesions were approached with gingival crevicular incisions with anterior vertical releases.

2.Subperiosteal dissection exposed the overlying bonebone was normal.

3.A drill was then used to remove the buccal cortical plate overlying the lesions.

 Both lesions was empty with no evidence of a lining or fluid content. In the anterior lesion, dental branches of the incisal neurovascular bundle were noted traversing the cavity.

4.Both lesions were curetted in an attempt to obtain tissue for histopathology.

 no soft tissue lining was encountered, so no tissue could be obtained for histopathologic analysis. Minimal bleeding was present in both cavities when curettage.

5.Apicoectomy and retrograde filling with super ethoxy benzoic acid were then performed on the mesial root of the lower left first molar tooth.

Post-OP follow-up:

panoramic radiograph: good bony filling of all lesions at 12 months including the symphyseal lesions that were not surgically explored

(4)

Discussion

1. Our case: A female adult patient with multiple unilocular lesions of the mandibular body and symphysis

2. Kaugars and Cale: traumatic bone cysts have an equal prevalence in both genders, mean age of 18 years, most often affect the posterior mandible(max. uncommon)

 this case was an older adult

3. Various hypotheses for the pathogenesis of the traumatic bone cyst:

(A) a traumatic event inciting medullary hemorrhage and a subsequent failure of the hematoma to organize and be replaced with tissue

 but 1.often there is no history of trauma 2. there is no difference in the prevalence between males and females despite a higher incidence of trauma in males.

(B) Cohen: the formation due to a blockage of the normal draining of interstitial fluid.

 1. as in our case, many traumatic bone cysts are found to be empty at surgery with no evidence of cyst fluid.

2. if the cyst developed because of a blockage of draining interstitial fluid, lesions would develop with a more equal frequency in all locations within the facial skeleton (C) Mirra et al: a small nest of synovium becomes trapped intraosseously during fetal or early infant development and that this tissue may retain some secretory function, resulting in the development of a cyst.

 neither of the surgical cavities entered showed any fluid content or evidence of a synovial lining.

 if synovial tissue exists within the cystic cavity, localized curettage to promote bleeding should not remove all of this tissue and cyst recurrence would seem likely.

Recurrence of a traumatic bone cyst after localized curettage is rare.

4. The etiology of the traumatic bone cyst, whether fluid accumulation plays a role in the initial development, and the potential source of the fluid of the traumatic bone cyst is unclear.

5. in our patient all symphyseal lesions resolved although only one was surgically entered.

 likely all of the symphyseal lesions were in communication, perhaps through very small sinusoids or channels.

6. The diagnosis of traumatic bone cyst relies on clinical, radiographic, and surgical

(5)

pathologic fracture has not been previously reported)

8. The diagnosis of orthopedic traumatic bone cysts relies on a typical radiographic appearance and aspiration of straw-colored fluid at surgery.

 It is possible that many traumatic bone cysts accumulate fluid after the fracture.

9. The diagnosis of maxillofacial traumatic bone cysts relies on a typical radiographic appearance and the more common identification of an empty cavity at surgery.

The original description of the traumatic bone cyst in the maxillofacial literature identified this cyst by the presence of clear cystic fluid at surgery

 may simply represent different stages in the development of the same lesion.

 Hansen: 66 traumatic bone cysts of the jaws with only 30 of the lesions being empty.

10. Computed tomography will usually allow distinction between solid/fluid-filled lesions and air-filled cavities.

11. Within the orthopedic literature, intralesional injection of methylprednisolone has been described as a treatment modality for traumatic bone cysts in the long bones.

12. A study comparing operative treatment and steroid injection in 57 patients with lower and upper extremity lesions resulted in a 38% recurrence rate after surgical intervention compared with 5% after steroid treatment.

 The steroid method may have equal efficacy but less morbidity compared with operative treatment.

13. The mechanism of action of corticosteroid is complex, with both anti-inflammatory properties and significant attenuation of cellular metabolism

14. Methylprednisolone has been shown to influence synovial cells to secrete less prostaglandin(前列腺素), resulting in a decrease in bone resorption

15. Further studies clarify the etiology and management of these curious lesions.

題號 題目

1 Traumatic bone cyst最常發生在何種年齡?

(A) 0~10 y/o (B) 10~20 y/o (C) 20~30 y/o (D) >50 y/o

答案(B) 出處:oral & maxillofacial pathology P550

題號 題目

2 下列何種物質會注射入Traumatic bone cyst for treatment?

(A) steroid

(B) Normal saline (C) Glucose water (D) Chlorhexidine

答案(A) 出處:oral & maxillofacial pathology P551

參考文獻

相關文件

(C) Differential diagnosis point between central giant cell granuloma and aneurysmal bone cyst is at the indentification of sinsusoidal blood spaces within the tumor mass1. (D)

We present a case of a 15- year-old male who presented with multiple papulo-nodular lesions in the central face and a family history of a similar type of lesions from his

CT scans showed expansile and densely mineralized lesions in all four quadrants with the left posterior mandible showing a focal penetration of the buccal cortical bone..

For 5 to be the precise limit of f(x) as x approaches 3, we must not only be able to bring the difference between f(x) and 5 below each of these three numbers; we must be able

[This function is named after the electrical engineer Oliver Heaviside (1850–1925) and can be used to describe an electric current that is switched on at time t = 0.] Its graph

• Cell coverage area: expected percentage of locations within a cell where the received power at these. locations is above a

• Cell coverage area: expected percentage of locations within a cell where the received power at these. locations is above a

 develop a better understanding of the design and the features of the English Language curriculum with an emphasis on the senior secondary level;..  gain an insight into the