口腔頜面部囊腫

Thecystsoforalregion鄭州大學(xué)口腔醫(yī)學(xué)院口腔病理教研室DepartmentofOralPathology,ZhengzhouUniversity,CollegeofStomatologyoralpathology鄭州大學(xué)2023/12/81口腔頜面部囊腫/學(xué)習(xí)要求掌握：牙源性角化囊腫、含牙囊腫、萌出囊腫、鼻腭管囊腫、腮裂囊腫、粘液囊腫及舌下囊腫的病理變化。熟悉：牙源性角化囊腫易復(fù)發(fā)的原因及組織來源；含牙囊腫、鼻腭管囊腫、腮裂囊腫的組織來源；粘液囊腫的發(fā)生過程。了解：口腔頜面部囊腫的分類；牙源性角化囊腫、含牙囊腫、鼻腭管囊腫、腮裂囊腫、粘液囊腫及舌下囊腫的臨床表現(xiàn)。2023/12/82鄭大口腔病理口腔頜面部囊腫/一般特點囊腫的概念：含流體、半流體或氣體的病理性囊腔，多數(shù)囊腫有上皮襯里假性囊腫：

與膿腫區(qū)別：囊腫的一般病理學(xué)特點：囊腔(囊內(nèi)容)、囊壁(纖維結(jié)締組織)、上皮襯里2023/12/83鄭大口腔病理口腔頜面部囊腫/一般病理特點wallepithelialliningcavity2023/12/84鄭大口腔病理口腔頜面部囊腫/一般特點分類：根據(jù)部位分：頜骨、軟組織根據(jù)來源分：上皮性(牙源性、非牙源性)非上皮性根據(jù)病因分：發(fā)育性、炎癥性2023/12/85鄭大口腔病理口腔頜面部囊腫/一般特點分類：一、頜骨囊腫：上皮性和非上皮性(一)上皮性：1.牙源性：發(fā)育性：牙源性角化囊腫，含牙囊腫，萌出囊腫，嬰兒“齦囊腫”，成人齦囊腫，發(fā)育性根側(cè)囊腫，腺牙源性囊腫炎癥性：根尖囊腫，根尖側(cè)囊腫，殘余囊腫，牙旁囊腫2.非牙源性：切牙管囊腫，鼻牙槽囊腫(二)非上皮性：單純性骨囊腫，動脈瘤性骨囊腫二、頜骨外(軟組織囊腫)皮樣或表皮樣囊腫，鰓裂囊腫，甲狀舌管囊腫，畸胎樣囊腫，粘液囊腫，舌下囊腫2023/12/86鄭大口腔病理口腔頜面部囊腫/一般特點牙源性：發(fā)育性：牙源性角化囊腫，含牙囊腫，萌出囊腫，嬰兒“齦囊腫”，成人齦囊腫，發(fā)育性根側(cè)囊腫，腺牙源性囊腫炎癥性：根尖囊腫，根尖側(cè)囊腫，殘余囊腫，牙旁囊腫囊腫不同，來源的殘余上皮不同1.Serres上皮剩余：牙源性角化囊腫，發(fā)育性根側(cè)囊腫，嬰兒“齦囊腫”，成人齦囊腫2.縮余釉上皮：含牙囊腫，萌出囊腫和牙旁囊腫3.Malassez上皮剩余：根尖囊腫，殘余囊腫，根尖側(cè)囊腫

2023/12/87鄭大口腔病理口腔頜面部囊腫/一般特點臨床：表現(xiàn)為瘤樣病變發(fā)生在頜骨者：膨大、乒乓球樣感、囊液常含膽固醇結(jié)晶，X線檢查見透光區(qū)，應(yīng)與腫瘤鑒別發(fā)生在軟組織：部位對診斷重要緩慢增大，無癥狀2023/12/88鄭大口腔病理Odontogenic

keratocyst(primordialcyst)Age:secondandthirddecades,fifthdecadesSex:morecommoninmalesthanfemalesLocation:70-80%occurinthemandible,especiallyinthethirdmolarregionandascendingramusSymptoms:few,secondarilyinflammed,enlargepredominantlyinanantero-posteriordirectionclinicalfeatures2023/12/89鄭大口腔病理Odontogenic

keratocystUnilocularormultilocularpatternAsmoothorscallopedborderradiographicfeatures2023/12/810鄭大口腔病理Odontogenic

keratocyst2023/12/811鄭大口腔病理牙源性角化囊腫/病理大體：囊壁薄，內(nèi)容為清液或血性，可見角化物，蛋白含量：＜3.5g/100ml鏡下：一、上皮：1.復(fù)層鱗狀上皮：無上皮釘突，有下皮下裂隙2.上皮表面正角化或不全角化，呈波浪狀3.棘細(xì)胞層較薄，呈細(xì)胞內(nèi)水腫4.基底細(xì)胞呈柵欄狀排列，核遠(yuǎn)離基底膜二、囊壁：纖維囊壁較薄，子囊、上皮團(tuán)、炎癥三、細(xì)胞增殖特點2023/12/812鄭大口腔病理Odontogenickeratocyst2023/12/813鄭大口腔病理Odontogenic

keratocyst2023/12/814鄭大口腔病理Odontogenic

keratocyst2023/12/815鄭大口腔病理Odontogenic

keratocyst2023/12/816鄭大口腔病理Odontogenic

keratocyst2023/12/817鄭大口腔病理Odontogenic

keratocyst2023/12/818鄭大口腔病理Odontogenic

keratocyst2023/12/819鄭大口腔病理Odontogenic

keratocyst2023/12/820鄭大口腔病理Odontogenic

keratocyst2023/12/821鄭大口腔病理Odontogenic

keratocyst2023/12/822鄭大口腔病理牙源性角化囊腫/復(fù)發(fā)復(fù)發(fā)傾向較其它囊腫高（5~62%）壁薄而脆，不易完整摘除生長方式特殊子囊和蕾狀上皮團(tuán)與囊腫的上皮來源有關(guān)（上皮剩余、粘膜基底細(xì)胞）2023/12/823鄭大口腔病理牙源性角化囊腫/相關(guān)綜合征痣樣基底細(xì)胞癌綜合征（nevoidbasalcellcarcinomasyndrome）Gorlin

綜合征多發(fā)性牙源性角化囊腫多發(fā)性皮膚痣樣基底細(xì)胞癌（軀干為主）骨骼異常：肋骨及其它骨特征性面形鈣磷代謝異常2023/12/824鄭大口腔病理痣樣基底細(xì)胞癌綜合征2023/12/825鄭大口腔病理OdontogenickeratocystpathogenisisDentallaminaoritsremnantsOffshootsofthebasallayeroforalepithelium2023/12/826鄭大口腔病理含牙囊腫（dentigerouscyst，或濾泡囊腫）

concept:acystwhichenclosesthecrownandisattachedtotheneckofanuneruptedtooth.Itdevelopsbyaccumulationoffluidbetweenthereducedenamelepitheliumandthecrown,orbetweenthelayersofthereducedenamelepithelium2023/12/827鄭大口腔病理dentigerouscystLocation:mandibularthirdmolar,themaxillarycanineandthirdmolar,andthemandibularsecondpremolar(阻生牙區(qū))Age:inthe2nd,3rdand4thdecadesSex:morefrequentlyinmalethaninfemale2023/12/828鄭大口腔病理dentigerouscystRadiographically(有特點，但不能作為診斷依據(jù))Awell-definedradiolucentareaassociatedwiththecrownofanuneruptedtooth.Oftentheradiolucentareasurroundsthecrown,butsometimesitliesmainlyorentirelytooneside2023/12/829鄭大口腔病理2023/12/830鄭大口腔病理含牙囊腫/病理大體：鏡下：AthinlayerofconnectivetissuelinedbyepitheliumthatmaybeonlytwoorthreecellsthickandthisresemblethereducedenamelepitheliumMucus-producingcells,ciliatedcellsKeratinizationinlimitedareas2023/12/831鄭大口腔病理2023/12/832鄭大口腔病理2023/12/833鄭大口腔病理含牙囊腫/萌出囊腫含牙囊腫的發(fā)生：縮余釉上皮與牙冠萌出囊腫（eruptioncyst）：含牙囊腫的特殊形式，發(fā)生在牙齦內(nèi)。2023/12/834鄭大口腔病理腺牙源性囊腫/一般特點glandularodontogeniccystorsialo-odontogeniccyst罕見可伴發(fā)成釉細(xì)胞瘤有復(fù)發(fā)傾向年齡、性別分布無特征

X線：單囊或多囊陰影2023/12/835鄭大口腔病理腺牙源性囊腫/病理epithelium：Stratifiedepitheliumhasasurfacelayerofacidophiliccuboidalorcolumnarcells,formingirregularpapillaryprojectionsCiliatedepitheliumcontainingmucus-producingcellsCryptorcyst-likespaceswithinthethicknessofepitheliumMucinmaybedemonstrablewithintheintraepithelialspacesandwithinthemaincystcavityEpithelialplaquemaybepresent2023/12/836鄭大口腔病理腺牙源性囊腫/病理Thefibrouscapsuleisusuallyfreefrominflammatorycells2023/12/837鄭大口腔病理腺牙源性囊腫/病理2023/12/838鄭大口腔病理腺牙源性囊腫/病理2023/12/839鄭大口腔病理腺牙源性囊腫/病理2023/12/840鄭大口腔病理鼻腭管囊腫/一般特點鼻腭管囊腫(nasopalatineductcyst)也稱切牙管囊腫(incisivecanalcyst)Acystarisingfromtheepithelialresiduesinthenasopalatine(incisive)canal2023/12/841鄭大口腔病理鼻腭管囊腫/一般特點Clinically,occurinthe4th,5thand6thdecades,andthereisathreetoonepreponderanceinmalesascomparedtofemales可發(fā)生于骨內(nèi)(切牙管)或骨外(切牙乳頭)Radiographically,thecystisfoundinthemidlineofthemaxillaasawell-definedround,ovoidorheart-shapedradiolucency，切牙窩深度6mm以下為正常，但超過無癥狀者觀察。2023/12/842鄭大口腔病理鼻腭管囊腫/病理Linedbystratefiedsquamousepithelium,pseudostratifiedciliatedcolumnarepitheliumorbothTheconnectivetissuewallcontainslargenervesandvessels;mucousglandsandadiposetissuemayalsobepresent2023/12/843鄭大口腔病理鼻腭管囊腫/病理2023/12/844鄭大口腔病理腮