Decompression treatment of children with large mandibular cystic lesions retrospective analysis of 12 cases of
【Abstract】 Objective To evaluate the decompression of the children of large mandibular cystic lesions of the therapeutic effects of the mandible in children, sexual
function preservation surgery in the application. Methods A retrospective analysis of 12 cases of children in a large mandibular cystic lesions in children, using decompression treatment, and treatment follow-up surveys to track. Results 3 months
after starting, facial bulge began to subside; until after 16 months or so when the children of the original 12 cases of facial swelling since returned to normal, X-ray
visible cysts disappeared completely. Conclusion decompression is the treatment of
children with large mandibular cystic lesions in an effective manner.
Key words Stomatognathic diseases / therapy; mouth neoplasms / therapy; cystic fibrosis; mandible; fenestration; children
Mandibular cystic lesions is a higher incidence of oral and maxillofacial a class of
benign tumor of children and young adults high. Common clinical large mandibular cystic lesions include the odontogenic keratocyst, cystic ameloblastoma, dentigerous cyst. Lesion often results in significant expansion of the mandible, deformed severely
resorbed cortical bone, teeth, occlusal relationship between shift rotation disorder. Occurred in children of mandible in patients with large cystic tumor, often resulting in permanent teeth can not be a normal eruption, severe dentofacial deformities.
The treatment of such diseases, according to the lesion location and size, can use different approaches to treatment. Traditional treatment methods are mainly used tumor curettage or segmental osteotomy. These methods tend to occur during the
treatment of mandibular pathologic fractures or bone defects, as well as the lower lip numbness and other symptoms of the mandibular neurovascular bundle injury, which seriously affected the children's quality of life. Therefore, to explore a function of both
saved and can effectively control the jaw morphology recurrence rate of treatment are particularly important.
Decompression of cystic lesions in the surface of windows, partial open bone and cyst, a cyst fluid drainage and to maintain unobstructed drainage port, so that cavity internal and external pressures to maintain a balance, bone regeneration after lesion, thus make cysts gradually decreased gradually restore jaw shape. In this paper, decompression of 12 children with a large mandibular cystic tumor in children were treated and achieved good effect, are summarized as follows reported.
A clinical data
1.1 General Information of Shenyang Stomatology Hospital Oral and Maxillofacial Surgery 2
in children with 12 cases, including 4 males and 8 females; aged 9 to 16 years old, with an average 12.45 years old; the shortest duration of six months, up to 3.5 years, an average of 1.5 years; for the dental cast in 9 cases, permanent Dentition in 3 cases. Pathology test results: dental cyst in 6 cases, 4 cases of odontogenic keratocyst, ameloblastoma in 2 cases. Clinically, all cases have shown from the side of facial swelling, palpation mandible are table tennis, or sac-like feeling sexy. Surface fault
films showed obvious visible light transmission of mandibular shadow of tumor in the mandible multi-body and l branch diameter exceeding 3 cm, cavity containing teeth in 7 cases.
1.2 treatment of children with normal preoperative preparations, carried out under local anesthesia fenestration. First select the window area, such as the tumor surface, obvious loose teeth or deciduous teeth, teeth can be extracted to remove alveolar
interval, expanding extraction wounds, as for the open window; such as the cases without extraction, using Intraoral incision, open window, select the bone cyst is weak areas, cutting transparent sticky periosteum, revealed lesion area, removal of 1.0 cm ×
2.0 cm cyst of the surface of cortical bone. After the cut to take the same size windows exposed pathological examination of the cyst into the organization in order to confirm the diagnosis. At the same time washing cysts, the cyst fluid and keratinized material
aspiration and intracavitary probe whether separated, open window to iodoform Vaseline gauze packing filling. In all cases 1 week after surgery, unpacking, while wearing the plug system for the production and device (with PMMA produced in order to clasp), maintaining unobstructed drainage port, will urge children with a daily self-
1.3 postoperative follow-up will urge Postoperative interval l ~ 3-month return visit
on a regular basis. Referral when the film surface compared with the preoperative CT
films at the same time check the open window, and to narrow the circumstances under the cysts gradually wear short cyst plug detection system device plugs into the cavity part.
1.4 Prognosis and outcome of all cases were followed up for 6 months to 2 years and
found that 12 cases of decompression in patients after 3 months, children with facial bulge gradually receded, children eventually bilateral facial symmetry. Panoramic films showed cystic bone regeneration around the alteration, cysts gradually reduced
back to the open window, was over the inferior alveolar neurovascular bundle restored to normal position. There have been five cases of children's teeth can automatically turn over and restore to normal teeth, jaw with the teeth to form a good occlusion. The
other two cases contained within the cavity of tooth movement to the alveolar crest below the orthodontic practitioner subsequently requested the assistance of traction to help Meng, combined with orthodontic treatment, teeth all the normal eruption,
normal build jaw.
Cystic tumor on the jaw mechanism for generating current domestic and international scholars has proposed several theories to explain the principles of the growth of cysts. These include mechanical theory of the piezoelectric effect of
orthodontic theory [1,2]. Therefore, in theory, as long as the removal or destruction of these factors can inhibit the growth of cysts. Reposted elsewhere in the paper for free download http://
Jaw mandibular cystic lesions will occur, the treatment of cyst removal surgery can be used, but the simple cyst removed after the high recurrence rate. In addition to a complete cyst should be removed, the need to scrape and grinding things addition to the
surrounding bone cyst, or carbolic acid, Carnoy fluid handling bone surface. As the mandibular cystic lesions are usually no clinical symptoms, children with treatment when the extent of the lesion is often large, resulting in tooth displacement, deformation
of cortical bone absorption, and even involving the condyle, clinical treatment more difficult. If the line of jaw removed children face shape and features will be greatly affected, especially children, are in maxillofacial growth and development period,
mandibular defects will be on their social life and family life have a significant impact. In addition, treatment of teeth within the cyst is very difficult. A wider range of mandibular cystic tumor often involving multiple teeth. The past, traditional treatment
methods require for the involved teeth should be given before surgery root canal therapy, surgery to prevent recurrence, are often required in apical resection, and even removal of the corresponding lesions of the teeth, which will virtually increase the
difficulty of surgery and risks as well as the cost of treatment. At the same time for the teeth included in the tumors, in particular the issue of permanent teeth for dental cast can not generally be retained. Because children are in for the Dental Multi-phase
extraction technique, if adopted, will inevitably cause the masticatory function of children affected by tooth loss and severe dentofacial deformities.
Certificate data are available literature, as early as the sixties and seventies in the
20th century, that is, some applications decompression surgery jaw cysts , although access to good clinical effect, but this treatment has not yet become mainstream, Only a small number reported in the literature. In recent years, with the functional surgery
and minimally invasive surgery concept proposed, according to this theory, scholars at home and abroad about the use of a large mandibular cystic fenestration for the treatment of cancer. Cyst fenestration therapy using the small incision through the oral
route, trauma, surgery should not relapse, children easily accepted, not only met the purpose of minimally invasive therapy, but also can guarantee that no extraoral scars will not affect the beauty of maxillofacial More importantly, through the fenestration
retain the integrity of the mandible to avoid the damage of the mandibular neurovascular bundle , so that children with the quality of life is not affected. While this treatment of a specific transformation mechanism and the control mechanism is
not yet clear, but the effects are very significant.
Childhood mandible cyst fenestration Another advantage of treating teeth, mouth treatment. Window treatment method used, due to lesions involving the tooth pulp vitality of the general will not be affected, with the exception obviously loose tooth, you can be considered for removal, through the extraction nest at an open window, generally in the lesions at the most protruding to open the window, without removal of teeth. And then gradually reduced as the tumor, the parties involving the root of the teeth will gradually have a new bone formation. For the same time, included in the cavity of the teeth, will be reduced as the tumor to the oral side approaches, when the alveolar crest to reach the bottom, through the method of orthodontic traction, you can make the final out of the normal tooth shade . Therefore, this treatment method can be retained to maximize the mouth of the teeth, will not be because of tooth loss Ershi masticatory function affected.
Through the analysis of cases in this group, I believe that cyst decompression surgery for children large mandibular cystic lesions, including the dentigerous cyst,
odontogenic keratocyst, and cystic ameloblastoma and so have a good effect . And the
children are at the peak of growth and development, osteogenic ability, healing cycle is short. There are five cases in this group were children's teeth can automatically turn over and restore to normal teeth, jaw and teeth to form a good bite on the relationship,
which no human intervention is difficult to achieve a therapeutic effect. And the open window size has a certain impact on efficacy. Found in the treatment, despite the cyst plug barrier, but with the shrinking of cysts, open the window has brought gradually
reduced, or even closed die. Therefore, I propose to open the window should be large enough diameter should normally be 1.0 ~ 2.0 cm. In addition, attention should be paid cavity washing, window children should have good compliance, window washing after
going to the regular cavity. On the one hand can be cyst cells of the capsule contents removed to reduce the osmotic pressure cavity; the other hand, can also prevent infection of intracavitary affect healing. Because children are less self-compliance, but
also their co-parents.
Although the window treatment of large mandibular cystic lesions has accumulated certain experience, but there are still some shortcomings need to be further to make up and improved. For example, a smaller sample size of cases is insufficient to establish the standard treatment program; another follow-up time is shorter. For the long-term
effect is not yet definite. The need for further time for observation.
 Ming-Wen. Stomatology Progress [M] .2 version. Wuhan: Hubei Science and
 Massara M de L, Gomes C de O, Magalhaes RC, et al.Odontogenic cyst: a conservative approach [J]. ASDC J Dent Child, 2000,67 (5): 360
 Xin-Quan, Chen Chuan-Jun, ZHANG Xiu-Li, et al. Human bone morphogenetic
protein-4 gene modified bone marrow stromal cells in ectopic bone test [J]. Oral and
 Ertas U, Yavuz MS.Interesting eruption of 4 teeth associated with a large
dentigerous cyst in mandible by only marsupialization [J]. J Oral Maxillofac Surg,