原文題目(出處)： Surgical management of dentigerous cyst and keratocystic odontogenic tumor in children: a conservative approach and 7-year follow-up. J Applied Oral Sci 2012;20:268-71
原文作者姓名： Maria Cristina Zindel DEBONI, Mariana Aparecida BROZOSKI, Andreia Aparecida TRAINA, Renata Rodrigues ACAY, Maria da Graca NACLERIO-HOMEM
通訊作者學校： Department of Oral Medicine and Oral Pathology, School of Dentistry, University of São Paulo, São Paulo, Brazil
報告者姓名(組別) Intern E 組 謝奇峰
Dentigerous cyst (DC) is one of the most common odontogenic cysts of the jaws and rarely recurs.
Keratocystic odontogenic tumor (KCOT), formerly known as odontogenic keratocyst (OKC), is considered a benign unicystic or multicystic intraosseous neoplasm and one of the most aggressive odontogenic lesions presenting relatively high recurrence rate and a tendency to invade adjacent tissue.
Two cases of these odontogenic lesions occurring in children are presented. They were very similar in clinical and radiographic characteristics, and both were treated by marsupialization. The treatment was chosen in order to preserve the associated permanent teeth with complementary orthodontic treatment to direct eruption of the associated permanent teeth.
At 7-years of follow-up, none of the cases showed recurrence.
Odontogenic cyst Low in children 4~9% in 1st decade
Impaction – entire removal Eruption possible – conservative Keratocystic
54.2% in 2nd ,3rd 4th decade
Decompression, marsupializtion, enucleation
Following by two cases of odontogenic lesion (dentigerous cyst & keratocystic odontogenic tumor), which were treated by marsupialization in order to preserve the associated permanent teeth.
III. CASE REPORT [Case 1]
8 y/o, male Chief complaint
Volume augmentation at left mandible, pain and fever for 1 week Radiographic findings
Unilocular radiolucent cystic lesion with scerotic border associated lateral incisor, canine,1st and 2nd premolars. Teeth dislocated apically and medially
Local bone aspiration ,incisional biopsy Microscopic findings
Capsule fragment lined by non-keratinized epithelium. Hemorrhagic areas were present.
- 1 -
The involved permanent teeth erupted naturally, without any traction forces
2nd premolar assumed an impacted position over the 1st premolar probably because of dental arch deficiency.
2nd premolar was removed under local anesthesia.
Lesion completely withdrawn, but lateral incisor still remained displaced.
Space-maintainer was installed, and referred to orthodontic treatment.
No lesion recurrence in radiographic follow-up.
1 year 7 years
10 y/o, female Chief complaint
Cystic-like lesion at right mandible on panoramic radiograph for ortho. tx.
Painless Oral examination
Slight swelling of alveolar mucosa related to primary molar and canine.
A segmented radiolucent area in the right mandible body presenting a sclerotic border. Inclusion and dislocation of the permanent canine, 1st and 2nd premolars were associated.
Local bone aspiration, incisional biopsy Microscopic findings
Capsule fragment presented a stratified epithelial lining with prominent columnar basal cell layer and parakeratinized daughter microcysts were scattered in the connective tissue wall
Keratocystic odontogenic tumor Treatment
In attempting to preserve permanent teeth, decompression procedure, extracting the primary molars and insertion of iodoform gauze.
Medication gauze was changed and daily care instruction as [Case 1]
Radiographic follow-up was performed periodically.
- 3 -
2 years 7 years
Dentigerous cyst & Keratocystic odontogenic tumor Histogenesis
− Defined as cysts of development of the dental follicle.
− Authors related them to traumatic pathology or inflammatory processes in primary teeth.
− Formerly OKC and classified as a neoplasm by WHO in 2005
− Benign odontogenic tumor derived from the dental lamina
− One of the major diagnostic criteria of nevoid basal cell carcinoma syndrome (NBCCS)
− that requires special surgical consideration because of its known aggressive behavior and high tendency to recur. Most surgeons support complete removal with extension margins or careful curettage of the surrounding tissues
Influenced by a variety of factors, including the length of the follow-up period, treatment modality, lesion size, histopathological presence of daughter cysts, and the number of cases investigated
− From 0% to 62%
− The majority occur within the first 5 years after treatment.
− Orthokeratinized OKCs is lower than the parakeratinized OKCs
Cases in this report
− Case 2 was parakeratinized type and exhibited daughter cysts ,but did not
- 5 -
Significant reduction confirmed trough radiographic imaging,
Secondary cystectomy to prevent recurrence
Probably rather less aggressive in growth characteristics
Cases in this report
− Conservative therapy
Age of the patients(first decade)
Development of tooth roots
Pressure relief allowing reduction of the intraosseous lesion and apposition of new bone to the cystic walls
− Decompression procedure here was done without the supplementary enucleation neither or application of Carnoy’s solution
Eruption of the associated impacted teeth may assumes an unusual position after marsupilization/decompression .
Cases in this report
− Present teeth came to eruption spontaneously
− Orthodontic treatment to assure better alignment of teeth
Although complete resolution by a conservative approach, long-term follow-up is still mandatory, especially the odontogenic keratocystic tumor.
1 Which of the followings is not the classic characteristic of keratocystic odontogenic tumor (KCOT)?
(A) Mandibular tendency ,especially body and ramus area (B) Tend to grow antero-posterior direction
(C) Associated to Gorlin syndrome
(D) Many recurrences after 5 years of original surgery
答案(D) 出處：Neville, Oral and Maxillofacial Pathology, 3rd Ed P.683
Which of the followings is true about follicular cysts?
(A) Also named dentigerous cysts
(B) Most often involve maxillary 3rd molars (C) Circumferential variety is most common (D) Wounld’t undergo neoplastic transformation
答案( A ) 出處：Neville, Oral and Maxillofacial Pathology, 3rd Ed.P679