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目的:探讨应用经口腔改良扩大刮治术治疗下颌骨巨型壁性成釉细胞瘤的治疗效果。方法:对2000—2010年收治的18例下颌骨巨型壁性成釉细胞瘤患者采用经口腔改良扩大刮治术(经口内切口刮除肿瘤;将术后骨腔浅层内壁以磨钻磨除;再以液氮冻融2次;填塞碘仿纱条,术后定期换药至骨腔平复)进行治疗,进行定期临床和影像学随访,随访期3个月~5a,评价治疗效果。结果:术后3个月,影像学显示术后骨腔开始缩小,部分新生骨钙化;术后6个月~1a,全部病例外形及颞下颌关节功能恢复良好,影像学显示术后骨腔明显缩小,可见堆积状新骨形成,新生骨明显钙化,骨皮质影像接近正常;术后1~1.5a,原膨隆的面部基本恢复正常,影像学显示术后骨腔内大量骨小梁形成,钙化良好,牙槽突高度略差;术后3.5~5a,骨腔体积平均缩小80%~90%,最小者为40%~50%。全部病例均未见肿瘤复发。结论:经口腔改良扩大刮治术治疗下颌骨巨型壁性成釉细胞瘤能有效去除肿瘤,显著缩小囊腔,促进新骨形成,改善面部畸形,有效恢复颞下颌关节的生理功能,保存下颌骨的连续性。
Objective: To investigate the treatment of mandibular giant ameloblastoma by oral surgery to improve the curettage. Methods: Twenty-eight patients with maxillary ameloblastoma of the mandible from 2000 to 2010 were treated with oral mastectomy and extended curettage ; And then frozen and thawed twice with liquid nitrogen; stuffed with iodoform gauze, regular dressing and bone resurfacing postoperatively) for regular clinical and imaging follow-up, follow-up period of 3 months to 5a, evaluate the therapeutic effect. Results: Three months after surgery, the imaging showed that the postoperative bone cavity began to shrink and some of the newborn bone calcification. After 6 months to 1a, the shape of all cases and the function of temporomandibular joint recovered well. The imaging showed obvious postoperative bone cavity Shrinkage, visible accumulation of new bone formation, new bone calcification, cortical bone imaging close to normal; 1 ~ 1.5a after surgery, the original bulge of the face back to normal, the imaging showed a large number of postoperative trabecular bone formation, calcification Good, slightly lower alveolar height; 3.5 ~ 5a after surgery, the average reduction of 80% to 90% of the cavity volume, the smallest of 40% to 50%. No cases of tumor recurrence in all cases. CONCLUSIONS: Oral improvement and scaling treatment of mandibular giant ameloblastoma can effectively remove the tumor, significantly reduce the cysts, promote new bone formation, improve facial deformity, effectively restore the temporomandibular joint physiological function, save the mandible Continuity.