Journal of the korean academy of Pediatric Dentistry (대한소아치과학회지)

Korean Academy of Pediatric Dentistry (대한소아치과학회)
권호 표지
DOI QR코드

DOI QR Code

Minimally Invasive Marsupialization for Treating Odontogenic Cysts: Case Reports

최소 침습적 조대술을 이용한 치성낭종의 치료 증례 보고

  • Ryu, Jiyeon (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Shin, Teo Jeon (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Hyun, Hong-Keun (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Kim, Youngjae (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Kim, Jungwook (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Kim, Chong-Chul (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Jang, Ki-Taeg (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Lee, Sang-Hoon (Department of Pediatric Dentistry, School of Dentistry, Seoul National University)
  • 류지연 (서울대학교 치과대학 소아치과학교실) ;
  • 신터전 (서울대학교 치과대학 소아치과학교실) ;
  • 현홍근 (서울대학교 치과대학 소아치과학교실) ;
  • 김영재 (서울대학교 치과대학 소아치과학교실) ;
  • 김정욱 (서울대학교 치과대학 소아치과학교실) ;
  • 김종철 (서울대학교 치과대학 소아치과학교실) ;
  • 장기택 (서울대학교 치과대학 소아치과학교실) ;
  • 이상훈 (서울대학교 치과대학 소아치과학교실)
  • Received : 2016.09.20
  • Accepted : 2016.11.16
  • Published : 2017.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

Marsupialization and decompression constitute a well-established procedure for treating cavitary bone lesions of the jaw. The technique can be a primary treatment option, especially for pediatric patients with large cysts or lesions involving vital anatomical structures, such as a developing tooth germ. In this procedure, a decompression stent, such as a customized acrylic obturator or space-maintaining appliance, silicone tube, or nasal cannula, is inserted to maintain the patency of the cyst. However, this may cause clinical problems, such as irritation or trauma to the adjacent tissues, as well as discomfort to the patient, or failure of the stent due to cyst shrinkage. It can also be a reason for patient noncompliance. In the cases described here, a minimally invasive marsupialization technique using a metal tube made from a 16-gauge needle was used for odontogenic cysts in pediatric patients associated with unerupted teeth. Through this method, the lesions were removed, with patient cooperation, and the cyst-associated teeth erupted spontaneously.

조대술 및 감압술은 악골내 치성기원 낭종에 대한 치료법으로서 여러 문헌을 통해 그 효과가 확립되어 왔다. 특히, 소아치과 영역에서 병소 크기가 크거나 발육 중인 치배 등 중요 구조물을 포함한 경우 보존적인 치료로서 우선적 대안이 될 수 있다. 조대술 후에는 낭종의 개방성 유지를 위해 맞춤 제작 아크릴 폐쇄장치(obturator) 또는 공간유지장치, 실리콘 관, 비강 캐눌라 등의 감압 스텐트(decompression stent)를 사용하는데, 이는 주변 연조직 자극 및 환아의 불편감, 낭종 크기 감소에 따른 탈락 가능성 등 임상적 문제점을 지니며 환아 협조도 저하의 원인이 되기도 한다. 본 증례들에서는 하악골 부위 영구 치배를 포함한 치성 낭종에 대하여 감압술시행시 16게이지 정맥 주사바늘을 활용한 금속관을 발치와를 통해 낭종 내부로 삽입하고 인접치에 레진으로 고정하는 최소 침습적 시술을 통해 환아의 양호한 협조하에 병소 제거 및 자발적 맹출을 유도하는 결과를 얻었기에 보고하는 바이다.

Keywords

References

  1. Enislidis G, Fock N, Sulzbacher I, Ewers R : Conservative treatment of large cystic lesions of the mandible: a prospective study of the effect of decompression. Br J Oral Maxillofac Surg, 42:546-550, 2004. https://doi.org/10.1016/S0266-4356(04)00152-4
  2. Berti Sde A, Pompermayer AB, et al. : Spontaneous eruption of a canine after marsupialization of an infected dentigerous cyst. Am J Orthod Dentofacial Orthop, 137:690-693, 2010. https://doi.org/10.1016/j.ajodo.2009.10.023
  3. Wiemer SJ, Pruitt CA, Rallis DJ, Viozzi CF : Use of a modified removable partial denture as a marsupialization stent in a pediatric patient. J Oral Maxillofac Surg, 71:1382-1386, 2013. https://doi.org/10.1016/j.joms.2013.02.003
  4. de Paulo LFB, da Cruz Perez DE, et al. : Giant facial dermoid cyst: A case treated by marsupialization. Revista Portuguesa de Estomatologia, Medicina Dentaria e Cirurgia Maxilofacial , 55:167-170, 2014. https://doi.org/10.1016/j.rpemd.2014.08.004
  5. Browne RM : The pathogenesis of odontogenic cysts a review. J Oral Pathol, 4:31-46, 1975. https://doi.org/10.1111/j.1600-0714.1975.tb01738.x
  6. Daley TD, Wysocki GP : The small dentigerous cyst. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 79:77-81, 1995. https://doi.org/10.1016/S1079-2104(05)80078-2
  7. Park C, Park K : Surgical Management of Dentigerous Cyst for Preserving Permanent Tooth Buds. J Korean Acad Pediatr Dent, 41:85-92, 2014. https://doi.org/10.5933/JKAPD.2014.41.1.85
  8. Benn A, Altini M : Dentigerous cysts of inflammatory origin A clinicopathologic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 81:203-209, 1996. https://doi.org/10.1016/S1079-2104(96)80416-1
  9. Pogrel MA : Treatment of keratocysts: the case for decompression and marsupialization. J Oral Maxillofac Surg, 63:1667-1673, 2005. https://doi.org/10.1016/j.joms.2005.08.008
  10. Gutmann JL, Gutmann MS : Historical Perspectives on the Evolution of Surgical Procedures in Endodontics. J Hist Dent, 58:1-42, 2010.
  11. August M, Faquin WC, Troulis MJ, Kaban LB : Dedifferentiation of odontogenic keratocyst epithelium after cyst decompression. J Oral Maxillofac Surg, 61:678-683, 2003. https://doi.org/10.1053/joms.2003.50137
  12. Carter LM, Carr P, Wales CJ, Whitfield PH : Customised stents for marsupialisation of jaw cysts. Br J Oral Maxillofac Surg, 45:429-431, 2007. https://doi.org/10.1016/j.bjoms.2006.10.014
  13. Uloopi KS, Shivaji RU, et al. : Conservative management of large radicular cysts associated with non-vital primary teeth: a case series and literature review. J Indian Soc Pedod Prev Dent, 33:53-56, 2015. https://doi.org/10.4103/0970-4388.149007
  14. Akay MC, Kaya E, Zeytinoglu M : Treatment of nonsyndromic dentigerous cysts in primary dentition. Clin Cosmet Investig Dent, 3:17-23, 2011. https://doi.org/10.2147/CCIDE.S17091
  15. Nakamura N, Mitsuyasu T, et al. : Marsupialization for odontogenic keratocysts: Long-term follow-up analysis of the effects and changes in growth characteristics. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 94:543-553, 2002. https://doi.org/10.1067/moe.2002.128022
  16. Jih M, Lee S, Lee N : Orthodontic Traction and Decompression Method in Treating Impacted Permanent Mandibular First Molars : Case Reports. J Korean Acad Pediatr Dent, 42:257-263, 2015. https://doi.org/10.5933/JKAPD.2015.42.3.257
  17. Kolokythas A, Schlieve T, Miloro M : Simple method for securing a decompression tube for odontogenic cysts and tumors: a technical note. J Oral Maxillofac Surg, 69:2392-2395, 2011. https://doi.org/10.1016/j.joms.2011.02.062
  18. Tolstunov L : Marsupialization catheter. J Oral Maxillofac Surg, 66:1077-1079, 2008. https://doi.org/10.1016/j.joms.2007.11.027
  19. Martinez-Perez D, Varela-Morales M : Conservative treatment of dentigerous cysts in children: a report of 4 cases. J Oral Maxillofac Surg, 59:331-333, 2001. https://doi.org/10.1053/joms.2001.21006