右下颌骨表皮样囊肿1例报道及文献回顾

Epidermoid cyst in the right mandible: a case report and literature review

摘要

目的 探讨颌骨表皮样囊肿的病因、发病机制、临床特点、诊断及治疗，为临床诊疗提供参考。 方法 分析1例发生于右下颌骨且伴有乳牙滞留、继承恒牙埋伏阻生的表皮样囊肿病例，并结合相关文献回顾分析。结果 患者主诉拍片发现右下颌骨肿物1个月；查体发现83乳牙滞留，43未萌出，83、44、45牙舌侧牙槽骨膨隆，无明显压痛，无波动感，未扪及乒乓球样感；影像学检查：83、44、45、46牙根尖部1.9 cm × 2.6 cm × 1.6 cm低密度影，包绕43牙冠；初步诊断为：①右下颌骨肿物，考虑含牙囊肿；②43牙埋伏阻生；③83牙乳牙滞留；静吸复合麻醉下行右下颌骨肿物摘除术、43及83牙拔除术；术中见肿物囊壁薄，内含豆渣样物质；组织病理学诊断为“右下颌骨肿物”表皮样囊肿；术后随访1周患者无不适，术区愈合良好。文献复习结果表明，表皮样囊肿是由异位外胚层组织发育而来的良性囊肿，可发生于全身，发生于口腔者较少，而位于颌骨者更是罕见；颌骨表皮样囊肿临床表现不具有特异性，易与含牙囊肿等牙源性囊肿及肿瘤混淆，牙髓活力测验等技术可为临床医生提供参考，确诊需借助组织病理学检查；手术摘除是常用治疗方法，预后良好，复发率低。结论 颌骨表皮样囊肿与颌骨囊肿具有相似的治疗原则，手术完整摘除囊肿预后良好。

Abstract

Objective To discuss the possible etiology, pathogenesis, clinical features, diagnosis and treatment of epidermoid cysts of the jaw and to provide a reference for clinical diagnosis and treatment. Methods A case of an epidermoid cyst in the right mandible with retained deciduous teeth and succedaneous impacted teeth was reviewed and analyzed in combination with the relevant literature. Results A patient presented with a mass in the right mandible that had persisted for 1 month after being found at imaging examination. Tooth 83 was retained, and tooth 43 was unerupted. Swelling was characterized by no obvious tenderness, fluctuation, or table tennis sensation and was observed in the lingual alveoli of teeth 83, 44, and 45. Imaging revealed a low-density shadow in the apex of teeth 83, 44, 45, and 46, approximately 1.9 cm × 2.6 cm × 1.6 cm in size, which wrapped around the dental crown of tooth 43. Preliminary diagnoses were as follows: right mandibular mass thought to be a dentigerous cyst; impacted tooth 43; and retained primary tooth 83. The mass in the right mandible was removed, and teeth 43 and 83 were extracted under intravenous and inhalation anesthesia. During the operation, the mass was observed to have a thin cyst wall and contained bean-like residue. Histopathological examination indicated an epidermoid cyst in the right mandible. At the 1-week follow-up examination, the patient reported no discomfort, and the surgical area showed good recovery. According to the literature, epidermoid cysts are benign cysts originating from ectopic ectodermal tissue that can occur throughout the body but rarely in the oral cavity and are even extremely rarer in the jaw. Epidermoid cysts of the jaw, which have no specific clinical manifestations, can be confused with odontogenic cysts such as dentigerous cysts and odontogenic tumors. Dental pulp tests and other techniques can serve as a reference for clinicians. The diagnosis is confirmed via histopathology. Surgical removal is a common treatment, with a good prognosis and a low recurrence rate. Conclusion The principle of treatment for an epidermoid cyst of the jaw is similar to that for a jaw cyst. The prognosis is good when the cyst is removed completely.

关键词

下颌骨 / 表皮样囊肿 / 乳牙滞留 / 埋伏牙 / 外胚层 / 锥形束CT / 牙髓活力测验

Key words

mandible / epidermoid cyst / retained primary teeth / impacted teeth / ectoderm / cone beam CT / dental pulp test

Author summay

林宇涵，医师，硕士，Email: [e-mail]