Objective: The aim of this retrospective study is to present the long-term effects of open healing of keratocystic odontogenic tumors (KCOTs) in the mandible.
Methods: A retrospective case series study was conducted on 41 patients with large KCOTs (the maximum diameter of the tumors exceeded 5 cm) treated at our institution between September 2003 and April 2011. A conservative surgical treatment was applied. The treatment involved enucleation of the primary lesion through narrow unroofing and open packing of the residual osseous defect with iodoform gauze for secondary healing. Bone regenera- tion and surgical complications were observed. The long-term effects of the treatment were followed up.
Results: The inferior alveolar nerve was exposed in the KCOT bone cavity in all cases, and some nerves adhered to the tumor tightly. The post- operative follow-up time was 81.5 months on the average (36 to 127 months). The packing gauze was changed every two weeks after enucleation, and the total duration time for packing was 8.9 months on the average (3 to 15 months). Notable bone regeneration and satisfactory secondary healing were observed clinically and radiographically. The KCOT-affected teeth were reserved, and their chewing functions were restored. Two cases presented recurrences after the initial treatment. The recurrence rate was 4.9% (2/41). No serious complications were observed.
Conclusion: Enucleation associated with subsequent open packing is a reliable treatment for patients with large KCOTs in the mandible.
目的: 观察下颌骨大型牙源性角化囊性瘤（KCOT）摘除术后开放愈合的长期预后。
方法: 于2003年9月—2011年4月通过手术治疗41例下颌骨大型KCOT（瘤腔最大径大于5 cm），采用口内切口摘除肿瘤，碘仿纱条填塞骨腔开放愈合，定期换药（每月2~3次）的治疗方式，观察术后并发症及骨再生修复情况，同时定期复查，观察肿瘤治疗远期预后。
结果: 所有病例术中均发现下牙槽神经暴露于囊腔，部分与肿瘤囊壁粘连较紧密。摘除肿瘤术后开放愈合时间平均为8.9个月（3~15个月），无术后出血、感染、永久性下颌神经损伤等并发症，病变骨腔逐渐缩小消失，骨再生良好；病变累及区域牙齿的牙髓可保持活性，牙齿也逐渐稳固；患者面型及咬合功能恢复满意。平均随访时间为81.5个月（36~127个月），术后复发2例，复发率4.9%（2/41）。
结论: 口内摘除肿瘤开放愈合的治疗方法显示出较为可靠的近远期治疗效果，可以为临床医师选择KCOT治疗方案提供参考。