악골에 발생한 낭종의 임상 및 병리조직학적 연구

Abstract

[한글]

악골에 발생하는 낭종(악골낭종)은 구강내에 흔히 발생되는 질환으로 종양성 병변은 아니지만 악골을 흡수시키고 안모변형을 초래하기도 하며 드물게는 종양으로 이행되는 잠재력을 갖고 있다. 그러나 그 종류가 다양하고 발생기전 및 분류와 임상적 형태 또한 다양하여 이에 관해 많은 논란이 되고 있다. 이에 저자는 악골낭종의 진단 및 치료에 도움이 되고자 1981년 11월부터 1991년 11월까지 최근 10년간 연세대학교 치과대학구강병리학교실에서 검색하여 악골낭종으로 진단되었던 198예를 대상으로 1990년 세계보건기구에서 채택한 분류법을 기준으로 하여 발생학적 고찰과 병리조직학적 재검경을 통해 재분류하는 한편 임상적 특성을 연구한 바 다음과 같은 결론을 얻었다.

1. 총 198예의 악골낭종중 발육성치성낭종이 64예 (32.3%), 발육성비치성낭종이 13예 (6.6%), 염증성낭종이 107예(54.1%), 기타 14예(7.1%)였으며, 치근단낭종이 96예(48.6%)로 가장 많았고 함치성낭종이 36예(18.2%), 각화성낭종이 26예(13.1%)를 보였다.

2. 연령별로는 20대에 가장 호발하였지만 (26.3%), 발육성치성낭종은 모든 연령층에 고루 분포되었고 발육성비치성낭종은 20대 이전에는 발생되지 않았으며 발육성치성낭종은 10대에, 염증성낭종은 27대에 호발하였다. 성별 발생비율은 전체적으로 1.9:1로 남자에서 호발하였으나 각 유형별로는 남성:여성의 비율이 발육성낭종은 2.7:1, 염증성낭종은 1.7:1, 기타 0.6:1로 유형별 차이가 있었으며 특히 함치성낭종, 염증성치주낭종 및 잔류성낭

종에서 남성에 현저히 호발하였다. 부위별 분포로는 상악에서 67.3%, 하악에서 32.7%가 발생되었고 특히 상악전치부에 52.1%로 호발하였다.

3. 악골낭종의 주요한 주소로는 종창 (49.7%), 동통(19.8%) 및 농삼출(12.2%)등 심미적 이상이나 염증과 관련된 주소의 발현이 높았고, 우연히 발견된 예가 15.7%에 불과해 조기진단의 중요성을 시사하였다.

4. 악골낭종의 재발은 각화성낭종에서만 관찰되어 이 낭종 26예중 4예(15.4%)에서 재발을 보였는데 방사선사진분석상 이 낭종에서 특히 다방성 및 다발성의 빈도가 높았던 것으로 보아(46.3%) 각화성낭종의 높은 재발율은 조직학적 특성 뿐 아니라 다방성 및 다발성과도 관련이 깊은 것으로 사료된다.

5. 악골에 발생한 낭종으로부터의 중양이행율은 충 198예중 10예(5%)로 모두 법랑아세포종으로 이행되었고 유형별로는 함치성낭종 36예중 7예(19.4%), 각화성낭종 26예중 2예(7.7%) 및 석회화낭종 3예중 1예에서 이행되어 함치성낭종에서의 종양이행율이 특히 높았

으며 암종으로 이행된 예는 관찰할 수 없었다.

CLINICO-HISTOPATHOLOGIC STUDY ON CYSTS OF THE JAW

JI HUN HAN

Department of Dental Science, Graduate School, Yonsei University

(Directed by Prif. Hyung Sik Park, D.D.S., M.S.D., Ph.D)

Cystic lesions of the jaw bone are frequently encountered clinically. Although

they rarely lead to development of tumors, they can result in resorption of the jaw

bone or asymmetry of the face may occur. Due to the numerous varieties, origin and

clinical features of cysts, classification has been controversial.

The present study is aimed to help find better understanding for the diagnosis

and treatment of jaw cysts. The material used in this study consists of the 198

cases of jaw cysts examined at the Department of Oral Pathology, the Dental College

of Yonsei University, for the period of November 1981 to November 1991.

Classification recommended by the World Health Organization in 1990 was applied to

reclassify the 198 cases by the embryologic consideration and histopathologic

re-examination. All cases were analysed with clinical and radiological findings.

The obtained results were as follows.

1. Of the total 198 cases, there were 64(32.3%) developmental odontogenic cysts,

13(6.6%) developmental nonodontogenic cysts, 107(54.1%) inflammatory cysts, and

14(7. 1%) others. Radicular cysts numbering 96(48.6%) cases were the most common,

followed by 36 dentigerous cysts(18.2%), and 26 odontogenic keratocysts(13.1%).

2. By age group, the 20's accounted for the largest proportion of the cases

(26.3%). Developmental odontogenic cysts were found evenly in all age groups and

developmental nonodontogenic cysts were not found in age groups below the 20's.

Developmental odontogenic cysts were most common in the 10's and inflammatory cysts

in the 20's. When all cases were totaled, the male to female ratio was 1.9:1. The

ratio was 2.7:1 for developmental cysts and 1.7:1 for inflammatory cysts. In

particular, dentigerous cases of developmental odontogenic cysts and paradental

cases of inflammatory cysts were predominantly common in males. By locaion, cysts

on the maxilla accounted for 67.7% and the mandible 32.3%. The anterior teeth of

the maxilla were the most common location (52.4%).

3. The chief complaints were swelling(49.7%), pain(19.8%), and pus

discharge(12.2%), indicating that most complaints were related to inflammation and

facial asymmetry. The cases which were discovered accidentally accounted for only

15.7% of the total, which attests to the importance of early diagnosis.

4. Recurrence of jaw cysts were observed only in odontogenic keratocysts, with 4

recurrences(15.4%) among 26 cases. Radiological analysis revealed the high

recurrence rate was especially high in multilocular cysts and multiple

cysts(46.3%). This indicates that the high recurrence rate of odontogenic

keratocysts was related not only to histologic evidence but also to the

multilocular and multiple characteristics.

5. Of the total 198 cases, 10 cases with neoplastic change were all ameloblstoma.

Dentigerous cysts showed a high neoplastic change rate with 7 cases(19.4%) of 36,

fellowed by 2 cases among 26 odontogenic keratocysts (7.7%), and 1 case of 3

keratinization cases. Malignant change was not observed in this study.

[영문]

Cystic lesions of the jaw bone are frequently encountered clinically. Although they rarely lead to development of tumors, they can result in resorption of the jaw bone or asymmetry of the face may occur. Due to the numerous varieties, origin and

clinical features of cysts, classification has been controversial.

The present study is aimed to help find better understanding for the diagnosis and treatment of jaw cysts. The material used in this study consists of the 198 cases of jaw cysts examined at the Department of Oral Pathology, the Dental College of Yonsei University, for the period of November 1981 to November 1991.

Classification recommended by the World Health Organization in 1990 was applied to reclassify the 198 cases by the embryologic consideration and histopathologic re-examination. All cases were analysed with clinical and radiological findings.

The obtained results were as follows.

1. Of the total 198 cases, there were 64(32.3%) developmental odontogenic cysts, 13(6.6%) developmental nonodontogenic cysts, 107(54.1%) inflammatory cysts, and 14(7. 1%) others. Radicular cysts numbering 96(48.6%) cases were the most common, followed by 36 dentigerous cysts(18.2%), and 26 odontogenic keratocysts(13.1%).

2. By age group, the 20's accounted for the largest proportion of the cases (26.3%). Developmental odontogenic cysts were found evenly in all age groups and developmental nonodontogenic cysts were not found in age groups below the 20's.

Developmental odontogenic cysts were most common in the 10's and inflammatory cysts in the 20's. When all cases were totaled, the male to female ratio was 1.9:1. The ratio was 2.7:1 for developmental cysts and 1.7:1 for inflammatory cysts. In

particular, dentigerous cases of developmental odontogenic cysts and paradental cases of inflammatory cysts were predominantly common in males. By locaion, cysts on the maxilla accounted for 67.7% and the mandible 32.3%. The anterior teeth of the maxilla were the most common location (52.4%).

3. The chief complaints were swelling(49.7%), pain(19.8%), and pus discharge(12.2%), indicating that most complaints were related to inflammation and facial asymmetry. The cases which were discovered accidentally accounted for only 15.7% of the total, which attests to the importance of early diagnosis.

4. Recurrence of jaw cysts were observed only in odontogenic keratocysts, with 4 recurrences(15.4%) among 26 cases. Radiological analysis revealed the high recurrence rate was especially high in multilocular cysts and multiple cysts(46.3%). This indicates that the high recurrence rate of odontogenic

keratocysts was related not only to histologic evidence but also to the multilocular and multiple characteristics.

5. Of the total 198 cases, 10 cases with neoplastic change were all ameloblstoma. Dentigerous cysts showed a high neoplastic change rate with 7 cases(19.4%) of 36, fellowed by 2 cases among 26 odontogenic keratocysts (7.7%), and 1 case of 3 keratinization cases. Malignant change was not observed in this study.