Odontojenik Kistlerin Cerrahi Tedavi Protokollerinin Değerlendirilmesi

Year 2023, Volume: 45 Issue: 4, 514 - 523, 20.07.2023

Nijat Aydınlı Nesrin Saruhan Ömür Dereci Fuat Açıkalın Yasin Koşar Görkem Tekin

https://doi.org/10.20515/otd.1298831

Abstract

Bu çalışmanın amacı odontojenik kaynaklı kistlerin tedavisinde kullanılan cerrahi yöntemleri değerlendirmek ve kemik iyileşmesini klinik ve radyolojik olarak değerlendirmektir. Çalışmaya Ağız, Diş ve Çene Cerrahisi kliniğinde 1 Ocak 2015-1 Ocak 2019 tarihleri arasında cerrahi tedavileri gerçekleştirilen ve histopatolojik olarak odontojenik kist tanısı almış hastalar dahil edilmiştir. Hastaların yaşı, cinsiyeti ve sistemik hastalıkları hem numerik hem de yüzde olarak değerlendirilmiştir. Kistik lezyonun vertikal olarak en geniş olduğu süperior-inferior (Sİ) ve horizontal olarak en yaygın olduğu mezio-distal (MD) mesafeler Romexis Viewer 3.4.1 programındaki ilgili dijital araç ile işaretlenerek pre-operatif olarak ve post-operatif 6. ayda alınmış panoramik radyografiler üzerinde ölçülüp kaydedilmiştir. Ayrıca pre-operatif ve post-operatif ölçümler arası farklar fark Sİ ve fark MD olarak kaydedilmiştir. Dahil edilme kriterleri göz önüne alındığında cerrahi olarak enükleasyon ve/veya marsupyalizasyon yapılan, histopatolojik olarak kist tanısı konmuş 38 hasta belirlenmiştir. Hastaların 23’ü (%39.5) erkek, 15’i (%60.5) kadındır. Histopatolojik değerlendirme sonucu bu hastaların 23’ünde (%60.5) radiküler, 9’unda (%23.7) dentigeröz, 6’sında (%15.8) keratokist olduğu tespit edilmiştir. Uygulanan tedavi şekline göre bu hastaların 17’sine (%44.7) marsüpalizasyon, 21’ine (%55.3) enükleasyon uygulanmıştır. Post-operatif 6. ayda kemik rejenerasyonunun marsüpyalizasyonla tedavide enükleasyona kıyasla istatistiksel olarak anlamlı olmasa da daha iyi sonuçlar gösterdiği görülmüştür(p>0,05). Fark Sİ değerinin mandibulada anlamlı olarak arrtığı gözlenmektedir (p<0.05). Fark MD ve Fark Sİ değerleri için diğer bütün parametreler açısından anlamlı fark bulunmamıştır (p>0.05). Odontojenik kistlerde en çok kullanılan tedavi yöntemleri enükleasyon ve marsüpyalizasyondur. Post-operatif 6. ayda her iki tedavi modalitesinin de kemik iyileşmesi açısından birbirine üstünlüğü bulunmamaktadır

Keywords

Cerrahi dekompresyon, Odontojenik kist, Enükleasyon

EVALUATION OF THE SURGICAL TREATMENT PROTOCOLS OF ODONTOGENIC CYSTS

Abstract

The aim of this study is to evaluate the surgical modalities used in the treatment of odontogenic cysts and examine the bone healing after surgical treatment. Patients who were treated surgically and histopathologically diagnosed as odontogenic cyst between January 1 2015 and January 1 2019 were included in the study. The vertical dimensions (SI) and horizontal dimensions (MD) of the cystic cavities were measured on the computer software program with appropriate measurement tool. The measurements were done on panoramic radiographs taken preoperatively and at postoperative 6th-month. The difference between preoperative and post-operative SI and MD measurements were also calculated. Thirty eight patients were included in the study. Fifteen of them (%60.5) were female and 23 (%39.5) of them were female. Twenty one patients (%55.3) were treated with enucleation and 17 patients (%44.7) were treated with marsupialisation. The number of patients who were histopathologically diagnosed as radicular cyst, dentigerous cyst and odontogenic keratocyst were 23 (%60.5), 9 (%23.7) and 6 (%15.8), respectively. The dimensions of cystic cavities did not show significant change at post-operative 6th-month follow-up period (p>0.05), however, increased bone regeneration was observed at marsupialization group. Difference SI was significantly higher in odontogenic cysts that were diagnosed on mandible (p<0.05), whereas all other parameters did not show statistically significant changes for difference MD and difference SI measurements. Enucleation and marsupialization are the most common surgical modalities used in the treatment of odontogenic cysts. Both treatment methods show similar levels of bone regeneration at the end of 6th-month follow-up.

Keywords

Surgical decompression, Odontogenic Cyst, Enucleation

References

• 1. Kramer IR. Changing views on oral disease. Proc R Soc Med. 1974;67:271-76.
• 2. Günhan Ö, Odontojenik ve Gelişimsel Çene Kistleri. Oral ve Maksillofasiyal Patoloji. Baskı Ankara: Atlas Kitapçılık Ltd. Şti; 2001. s. 21.
• 3. Williams, T. ve J. Hellstein, Odontogenic cysts of the jaws and other selected cysts. William, TP, Stewart JCB. 5th Edition Philadelphia: WB Saunders, 2000: p. 297-317.
• 4. Harris M. Odontogenic cyst growth and prostaglandin-induced bone resorption. Ann R Coll Surg Engl 1978;60:85-91.
• 5. Gelețu GL, Burlacu A, Baciu ER, Diaconu-Popa D, Murariu A, Foia LG, Ungureanu L, Onică N. Various Surgical Interventions in Treating Odontogenic Keratocyst: A Radiological Case Report. Healthcare (Basel). 2023 1;11:416.
• 6. Khalil A, Albash Z, Sleman N, Sayegh W. Marsupialization and peripheral ostectomy for the management of large odontogenic keratocyst: a case report. J Surg Case Rep. 2023r 17;2023:rjad119.
• 7. Wushou A, Zhao YJ, Shao ZM. Marsupialization is the optimal treatment approach for keratocystic odontogenic tumour. J Craniomaxillofac Surg 2014;42:1540-44.
• 8. Dong Q, Pan S, Sun LS, Li TJ. Orthokeratinized odontogenic cyst: a clinicopathologic study of 61 cases. Arch Pathol Lab Med 2010;134:271-75.
• 9. Thoma KH. The new Department of Stomatology at the School of Medicine, Boston University. Oral Surg Oral Med Oral Pathol 1958;11:937-38.
• 10. Brøndum N, Jensen VJ. Recurrence of keratocysts and decompression treatment. A long-term follow-up of forty-four cases. Oral Surg Oral Med Oral Pathol 1991;72:265-69.
• 11. Padmakumar S. Cysts of the jaws in pediatric population: A 12-year institutional study. Oral Maxillofac Pathol J 2015. 6: p. 532-36.
• 12. Avelar RL, Antunes AA, Carvalho RW, Bezerra PG, Oliveira Neto PJ, Andrade ES. Odontogenic cysts: a clinicopathological study of 507 cases. J Oral Sci 2009;51:581-86.
• 13. Gültelkin SE, Tokman B, Türkseven MR. A review of paediatric oral biopsies in Turkey. Int Dent J 2003;53:26-32.
• 14. Jones AV, Craig GT, Franklin CD. Range and demographics of odontogenic cysts diagnosed in a UK population over a 30-year period. J Oral Pathol Med 2006;35:500-507.
• 15. Tortorici S, Amodio E, Massenti MF, Buzzanca ML, Burruano F, Vitale F. Prevalence and distribution of odontogenic cysts in Sicily: 1986-2005. J Oral Sci 2008;50:15-18.
• 16. Koseoglu BG, Atalay B, Erdem MA. Odontogenic cysts: a clinical study of 90 cases. J Oral Sci 2004;46:253-57.
• 17. Ochsenius G, Escobar E, Godoy L, Peñafiel C. Odontogenic cysts: analysis of 2,944 cases in Chile. Med Oral Patol Oral Cir Bucal 2007;12(2):E85-E91.
• 18. Kambalimath DH, Kambalimath HV, Agrawal SM, Singh, M., Jain, N., Anurag, B., & Michael, P. Prevalence and distribution of odontogenic cyst in Indian population: a 10 year retrospective study. J Maxillofac Oral Surg 2014;13:10- 15.
• 19. Trott JR, Esty C. An analysis of 105 dental cysts. J Can Dent Assoc (Tor) 1972;38:75-78.
• 20. Serra VG, Odontogenic cysts in children and adolescents: a 21-year retrospective study. Brazilian Journal of Oral Sciences 2012;11: p. 81-83.
• 21. Scholl RJ, Kellett HM, Neumann DP, Lurie AG. Cysts and cystic lesions of the mandible: clinical and radiologic-histopathologic review. Radiographics 1999;19:1107-24.
• 22. Kim YH and Lee EW, Comparison of clinico-histopathologic findings before and after decompression of odontogenic cyst in the jaw. J Korean Assoc Oral Maxillofac Surg 2005;31:150-160.
• 23. Macdonald-Jankowski DS. Glandular odontogenic cyst: systematic review. Dentomaxillofac Radiol 2010;39:127-39.
• 24. Skinner RL, Davenport WD Jr, Weir JC, Carr RF. A survey of biopsied oral lesions in pediatric dental patients. Pediatr Dent 1986;8:163-67.
• 25. Sánchez-Burgos R, González-Martín-Moro J, Pérez-Fernández E, Burgueño- García M. Clinical, radiological and therapeutic features of keratocystic
• 26. El Gehani R, Krishnan B, Orafi H. The prevalence of inflammatory and developmental odontogenic cysts in a libyan population. Libyan J Med 2008;3:75-77.
• 27. Chiapasco M, Rossi A, Motta JJ, Crescentini M. Spontaneous bone regeneration after enucleation of large mandibular cysts: a radiographic computed analysis of 27 consecutive cases. J Oral Maxillofac Surg 2000;58:942-49.
• 28. Koşar YÇ, Saruhan N, Dereci Ö. The Comparative Analysis of Cone Beam Computed Tomography and Panoramic Radiography in the Radiological Evaluation of Spontaneous Bone Regeneration in Jaw Cysts after Enucleation. J Biotechinol & Strategic Health Res. 2019; 3: 203-207.
• 29. Bodner L, Woldenberg Y, Bar-Ziv J. Radiographic features of large cystic lesions of the jaws in children. Pediatr Radiol 2003;33:3-6.
• 30. Oba T, Katayama H. Comparison of orthopantomography with conventional periapical dental radiography. Oral Surg Oral Med Oral Pathol 1972;34:524- 30.
• 31. Nuñez-Urrutia S, Figueiredo R, Gay-Escoda C. Retrospective clinicopathological study of 418 odontogenic cysts. Med Oral Patol Oral Cir Bucal 2010;15:e767- e773
• 32. Tuncay U, Kürklü E, Dursun G, Ertaş B. Maksiller sinüste sürekli kanin dişi le ilişkili dentiger z kist/Dentigerous cyst involving t e maxillary sinus associated wit permanent canine teeth. J Istanb Univ Fac Dent 2006;40:27-31.