Extirpating Mandibular Odontogenic Keratocyst through Sagittal Split Approach-A Case Report & Literatures Review

經矢狀劈開截骨術根除下頷骨齒源性角化囊腫－案例報告暨文獻回顧

陳良誠(Liang-Cheng Chen) ； 陳遠謙(Michael Yuan-Chien Chen) ； 施皓(Hao Shih)

《臺灣口腔顎面外科學會雜誌》 32卷2期 (2021/06) Pp. 150-162

摘要

Various surgical techniques have been proposed for odontogenic keratocyst (OKC) treatment in light of its high recurrence rate and aggressiveness. Surgical interventions include conservative treatments such as enucleation and marsupialization as well as aggressive surgeries such as peripheral ostectomy and resection. However, no gold standard treatment has yet been established. Large cystic lesions in the retromolar region extending into the ascending ramus make surgery challenging. The aim of this study was to develop a novel approach to remove an OKC present in the left body of the mandible in a young adult patient through unilateral sagittal splitting of the mandible. Considering the broad involvement of a large lesion at the mandibular body, sagittal split osteotomy could not only increase the surgical access to the OKC but also help in avoiding trauma to the inferior alveolar nerve. Although some risks remain, such as malocclusion, postoperative intermaxillary fixation, or the need for a soft diet, patients' facial appearance, occlusion, and other clinical outcomes remain stable. In conclusion, the sagittal split approach is advantageous for OKC removal and is a practical option for cyst enucleation.

關鍵字

Odontogenic Keratocyst ； Sagittal Split Osteotomy ； Cyst enucleation ； Mandible

並列摘要

鑑於齒源性角化囊腫的高複發率和侵襲性，許多用於牙源性角化囊腫治療的手術方式被提出。手術方式包括保守性治療，例如摘除手術和造袋術，以及積極的手術，例如外周骨切除術和切除術。然而至今尚無標準治療方法。此外，當面臨較大且延伸至下顎枝之齒源性角化囊腫，手術面臨更多的挑戰性。這項研究的目的用於闡明一種新穎的方法，通過單側矢狀劈開下頜骨以摘除年患者下頜骨體中的齒源性角化囊腫。當面臨到下頜體較大範圍之病灶，矢狀劈開截骨術不僅可以增加手術視野及操作空間，還能避免對下牙槽神經的損傷。儘管仍然存其他風險，例如咬合不正，術後頜間固定及飲食調整，然而患者的面部外觀，咬合和其他臨床結果仍保持穩定。總結而言，矢狀劈開截骨術有利於齒源性角化囊腫切除，是囊腫摘除合理的手術方法之一。

並列關鍵字

齒源性角化囊腫 ； 矢狀劈開截骨術 ； 囊腫剜除術 ； 下顎骨