单囊性成釉细胞瘤的保守治疗1例

S. Agarwal
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摘要

成釉细胞瘤是颌骨最常见的良性牙源性肿瘤,约占颌骨所有囊肿和肿瘤的1% 1,2。它通常是一种无痛,生长缓慢,局部侵袭性肿瘤,引起骨皮质扩张,舌或颊皮质板穿孔和软组织浸润。它在生命的第三和第四个十年发病率最高,但可以在任何年龄组中发现,性别偏好相同(1:1)1,5。据报道,下颌骨与上颌骨的相对频率从80% -20%到99-1%不等。在下颌骨,大多数成釉细胞瘤发生在磨牙支区。在常规x线片上,成釉细胞瘤可以表现为单室或多室的皮质透光度。骨性隔形成蜂巢、肥皂泡或网球拍的外观。在某些地方,皮质板块被保留并扩展,而在其他地区,它们被破坏;牙根吸收是一种常见的发现。颊部和舌部皮层板扩张在成釉细胞瘤中比在其他肿瘤中更常见7。常规x线片对下颌小病变就足够了,但上颌病变和广泛病变需要CBCT、CT和MRI来确定病变的范围7。治疗成釉细胞瘤的挑战是当肿瘤很大时,如何实现完全切除和重建缺陷。根据病变的大小和类型,成釉细胞瘤的治疗方法有去核、刮除或手术切除,也有保守治疗。本报告全面介绍了碘仿石蜡膏在牙源性肿瘤治疗中的应用。
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Conservative Management of Unicystic Ameloblastoma- A Case Report
Ameloblastoma is the most common benign odontogenic tumor of the jaws that constitutes about 1% of all cysts and tumors of the jaws1,2. It is generally a painless, slow growing, locally aggressive tumor causing expansion of the cortical bone, perforation of the lingual or the buccal cortical plate and infiltration to the soft tissues. It has peak incidence in third and fourth decade of life but can be found in any age group with equal gender predilection (1:1)1,5. The relative frequency of mandible to maxilla is reported to be varying from 80% -20% to 99–1%. In the mandible majority of Ameloblastoma are found in the molar ramus region1,3. In a conventional radiograph, Ameloblastoma can present as either unilocular or multilocular corticated radiolucency. The bony septae results in a honey comb, soap bubble or tennis racket appearance. In some places, cortical plates are spared and expanded where as in other region they are destroyed; root resorption is a common finding6. Buccal and lingual cortical plate expansion is more common in Ameloblastoma than in other tumour7. Conventional radiograph is sufficient for small mandibular lesions but maxillary lesions and extensive lesions require CBCT, CT and MRI to establish the extent of the lesion7. The challenge in managing Ameloblastoma is by attaining complete excision and reconstruction of the defect when the tumor is large. Ameloblastoma is treated by enucleation, curettage or surgical excision depending on size and type of the lesion and conservative therapy also. This report gives a comprehensive knowledge regarding the conservative therapy using a  Iodoform and paraffin paste which has been a boon in treatment of odontogenic tumor.
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