Odontogenic and nonodontogenic jaw cysts: experience in 25 cases

Year 2008, Volume: 18 Issue: 3, 157 - 165, 25.06.2008

Hakan Ağır Cenk Şen Eda Işıl Çiğdem Ünal Emre Üstündağ Gürkan Keskin

Abstract

Objectives: We retrospectively evaluated the patients with jaw cysts treated at our center. Patients and Methods: The study included 25 patients 14 males, 11 females; mean age 33±19 years; range 7 to 69 years who underwent surgery for odontogenic or nonodontogenic jaw cysts. Results: The most common presentation was a swelling in the jaw with or without dental problems. Involvement was in the mandible in 18 patients, and in the maxilla in seven patients. The lesions consisted of eight radicular, six dentigerous, two nasoalveolar, two globulomaxillary cysts, and three keratocysts. Four patients had gingival, nasopalatine, residual, and median mandibular cysts, respectively. Marsupialization, curettage, extensive burring, enucleation, or marginal resection were performed depending on pre- and intraoperative findings. The defects were repaired with a corticocancellous iliac bone block graft in three patients and cancellous iliac bone chips in five patients. During a mean follow-up of 14 months range 12 to 46 months , recurrence was seen in only one patient with a keratocyst. Conclusion: A good preoperative assessment, complete removal of the cystic lesion, and close radiographic follow-up are essential for a successful outcome in jaw cysts. In selected cases, reconstruction of the defects with autogenous corticocancellous iliac bone graft yields highly satisfactory results.

Keywords

Jaw neoplasms, mandibular diseases, maxillary diseases, odontogenic cysts/surgery

Çenenin odontojenik ve odontojenik olmayan kistleri: 25 olguda deneyimlerimiz

Abstract

Amaç: Çene kisti tanısı ile tedavi edilen hastalar geriye dönük olarak incelendi. Hastalar ve Yöntemler: Çenede odontojenik ve odontojenik olmayan kist tanısı ile tedavi ve takip edilen 25 hasta 14 erkek, 11 kadın; ort. yaş 33±19; dağılım 7-69 değerlendirmeye alındı. Bulgular: En sık başvuru nedeni çenede şişlik ve diş sorunları idi. Kistlerin 18’i mandibula, yedisi maksilla yerleşimli idi. Olguların sekizinde radiküler kist, altısında dentigeröz kist, üçünde keratokist, ikisinde nazoalveoler kist, ikisinde globulomaksiller kist, birer olguda da gingiva kisti, nazopalatin kist, rezidüel kist ve median mandibula kisti vardı. Tanılarına ve ameliyat bulgularına göre olgularda marsupiyalizasyon, küretaj, tur ile aşındırma, enükleasyon veya marjinal rezeksiyon uygulandı. Oluşan kaviteyi kapatmak için kullanılan iliyak kemik grefti üç olguda kortikokansellöz blok, beş olguda kansellöz cips olarak tercih edildi. İzlem süresi ortalama 14 ay dağılım 12-46 ay idi. Nüks sadece bir keratokist olgusunda gözlendi. Sonuç: Çene kistlerinde ameliyat öncesi değerlendirme, lezyonun tümüyle çıkarılması ve radyografik kontroller, tedavide başarı için önemlidir. Seçilmiş olgularda, oluşan kemik defektinin otojen kortikokansellöz iliyak kemik grefti ile kapatılması iyi sonuçlar vermektedir.

Keywords

Çene neoplazileri, mandibuler hastalık, maksiller hastalık, odontojenik kist/surgery

References

• Borah GL, Aziz SR. Tumors of the mandible. In: Mathes SJ, Hentz VR, editors. Plastic surgery. Vol. 5, 2nd ed. Philadelphia: W. B. Saunders; 2006. p. 91-157.
• Jackson IT, Shaw K. Tumors of the craniofacial skele- ton, including the jaws. In: McCarthy JG, editor. Plastic Surgery. Vol. 5. Philadelphia: W. B. Saunders; 1990. p. 3336-411.
• Browne RM. The pathogenesis of odontogenic cysts: a review. J Oral Pathol 1975;4:31-46.
• Boyd JB, Assad CJ. The mandible. In: Achauer BM, Eriksson E, Coleman JJ, Kolk CV, Russell RC, Guyuron B, editors. Plastic surgery: indications, operations, and outcomes. Vol. 3, St. Louis: Mosby; 2000. p. 1233-77.
• Shear M. Classification and frequency of cysts of the oral and maxillofacial tissues. In: Shear M. Cysts of the oral regions. 2nd ed. Boston: Wright-PSG; 1983. p. 10-5.
• Shafer WG, Hine MK, Levy BM, editors. Benign and malignant tumors of the oral cavity. In: A textbook of oral pathology. 4th ed. Phiadelphia: W. B. Saunders; 1983. p. 76-85.
• Ertaş NM, Bağdatlı D, Gündeşlioğlu Ö, Karamürsel S, Velidedeoğlu H, Çelebioğlu S. Üst ve alt çenenin solid ve kistik kitleleri. Türk Plastik, Rekonstrüktif ve Estetik Cerrahi Dergisi. 2002;10:165-9.
• Philipsen HP, Reichart PA. Calcifying epithelial odon- togenic tumour: biological profile based on 181 cases from the literature. Oral Oncol 2000;36:17-26.
• Wysocki GP, Brannon RB, Gardner DG, Sapp P. Histogenesis of the lateral periodontal cyst and the gingival cyst of the adult. Oral Surg Oral Med Oral Pathol 1980;50:327-34.
• Altini M, Farman AG. The calcifying odontogenic cyst. Eight new cases and a review of the literature. Oral Surg Oral Med Oral Pathol 1975;40:751-9.
• Ellis E, Fonseca RJ. The management of odontogenic cysts and tumors. In: Thawley SE, Panje WR, edi- tors. Comprehensive management of head and neck tumors. Philadelphia: W. B. Saunders; 1987. p. 1483-97.
• Georgiade NG, McGraw TA, Georgiade GS. Solid and cystic tumors of the jaw. In: Georgiade GS, Riefkohl R, Levin LS, editors. Plastic, maxillofacial and reconstruc- tive surgery. 3rd ed. Baltimore: Williams&Wilkins; 1997. p. 436-45.
• Cataldo E, Berkman MD. Cysts of the oral mucosa in newborns. Am J Dis Child 1968;116:44-8.
• Jones AV, Craig GT, Franklin CD. Range and demo- graphics of odontogenic cysts diagnosed in a UK population over a 30-year period. J Oral Pathol Med 2006;35:500-7.
• Varinauskas V, Gervickas A, Kavoliuniene O. Analysis of odontogenic cysts of the jaws. Medicina 2006;42:201-7.
• Gardner DG. Residual cysts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:114-5.
• Gardner DG. An evaluation of reported cases of medi- an mandibular cysts. Oral Surg Oral Med Oral Pathol 1988;65:208-13.
• Chirapathomsakul D, Sastravaha P, Jansisyanont P. A review of odontogenic keratocysts and the behavior of recurrences. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:5-9.
• Williams TP. Commentary to “A review of odontogen- ic keratocysts and behavior of recurrences”. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:10.
• Velich N, Nemeth Z, Hrabak K, Suba Z, Szabo G. Repair of bony defect with combination biomaterials. J Craniofac Surg 2004;15:11-5.
• Chima KK, Seldin EB, Dodson TB. Comparison of wound management methods after removal of max- illofacial osseous lesions. J Oral Maxillofac Surg 2006;64:1398-403.
• Pradel W, Eckelt U, Lauer G. Bone regeneration after enucleation of mandibular cysts: comparing autog- enous grafts from tissue-engineered bone and iliac bone. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:285-90.
• Horch HH, Sader R, Pautke C, Neff A, Deppe H, Kolk A. Synthetic, pure-phase beta-tricalcium phosphate ceramic granules (Cerasorb) for bone regeneration in the reconstructive surgery of the jaws. Int J Oral Maxillofac Surg 2006;35:708-13.
• Kiyokawa K, Kiyokawa M, Tai Y, Tanaka S. New regenerative surgical treatment of cystic diseases of the jaw by utilizing grafting of cancellous iliac bone and replanting of patient’s teeth. J Craniofac Surg 2004;15:792-6.
• Kim JH, Rosenthal EL, Ellis T, Wax MK. Radial forearm osteocutaneous free flap in maxillofacial and oromandibular reconstructions. Laryngoscope 2005;115:1697-701.
• Ozkan O. Single osteotomized iliac crest free flap in anterior mandible reconstruction. Microsurgery 2006;26:93-9.
• Urken ML, Bridger AG, Zur KB, Genden EM. The scap- ular osteofasciocutaneous flap: a 12-year experience. Arch Otolaryngol Head Neck Surg 2001;127:862-9.
• Gerzenshtein J, Zhang F, Caplan J, Anand V, Lineaweaver W. Immediate mandibular reconstruc- tion with microsurgical fibula flap transfer following wide resection for ameloblastoma. J Craniofac Surg 2006;17:178-82.
• Aydin A, Emekli U, Erer M, Hafiz G. Fibula free flap for mandible reconstruction. Kulak Burun Bogaz Ihtis Derg 2004;13:62-6.
• Morgan TA, Burton CC, Qian F. A retrospective review of treatment of the odontogenic keratocyst. J Oral Maxillofac Surg 2005;63:635-9.
• Bataineh AB, al Qudah M. Treatment of mandibular odontogenic keratocysts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:42-7.