歯原性角化のう胞の再発に関する検討

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  • Analysis of odontogenic keratocysts with recurrence.

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Clinical, radiographic and histologic features of 6 recurrent odontogenic keratocysts that developed in 5 patients were described.<BR>The rate of recurrence in 28 cases with a minimum of one year follow-up was 21.4% that corresponded well to the average rate reported in other studies. The recurrence was noted 9 months to 5 years after treatment. The results indicated the necessity of regular and long-term follow-up because of the absence of symptoms associated with recurrence in most cases. The mean age of the patients was 16.6 years which was significantly lower than that of patients wthout recurrence.<BR>Radiographically, the lesions were unilocular in 4 cases with smooth or scalloping borders and multilocular in other cases. Three cases manifested themselves as huge radiolucent lesions extending from the molar area to the mandibular notch. The initial lesions were also extending over 5 teeth in 2 of 3 cases that developed in the tooth bearing area, but the huge size was not the findings characteristic of the recurrent cases. The cysts were associated with impacted teeth in 5 cases, but the condition could not be regarded as the cause of recurrence. In terms of location, there was no predilecton in the site of recurrence.<BR>Five of the 6 cysts had been treated by marsupialization followed by enucleation and primary closure, whereas recurrence was found in no case in which marsupialization, marsupialization followed by enucleation and packing open, enucleation and packing open or block resection were performed. Thus, treatment modality was the most important prognostic factor. Because of the various advantages of marsupialization, we are still in favor of the procedure in the treatment of the cyst occurring in young patients. When enucleation should be considered after marsupialization, however, the utmost care should be taken to remove the cyst en bloc with a margin of safety to include the soft tissue over the areas of bony defect and a layer of the surrounding bone to which it may be adhered and leave the wound to heal secondarily.<BR>The presence of epithelial islands or daughter cysts in the cystic wall could not be correlated the recurrence.

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