口腔颌面部囊肿课件

膜基底细胞）
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牙源性角化囊肿/相关综合征
痣样基底细胞癌综合征（nevoid basal cell carcinoma syndrome）Gorlin 综 合征 n 多发性牙源性角化囊肿 n 多发性皮肤痣样基底细胞癌（躯干为主） n 骨骼异常：肋骨及其它骨 n 特征性面形 n 钙磷代谢异常
n Mucus-producing cells, ciliated cells n Keratinization in limited areas
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含牙囊肿/萌出囊肿
n 含牙囊肿的发生：缩余釉上皮与牙冠 n 萌出囊肿（eruption cyst）：含牙囊肿的特
殊形式，发生在牙龈内。
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腺牙源性囊肿/一般特点
n glandular odontogenic cyst or sialo-odontogenic cyst 罕见
n 可伴发成釉细胞瘤 n 有复发倾向 n 年龄、性别分布无特征 n X线：单囊或多囊阴影
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口腔颌面部囊肿/一般病理特点
wall epithelial lining
cavity
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口腔颌面部囊肿/一般特点
分类：
n 根据部位分：颌骨、软组织 n 根据来源分：
上皮性(牙源性、非牙源性) 非上皮性 n 根据病因分：发育性、炎症性
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Odontogenic keratocyst
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Odontogenic keratocyst
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Odontogenic keratocyst
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Odontogenic keratocyst
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Odontogenic keratocyst
radiographic features
n Unilocular or multilocular pattern n A smooth or scalloped border
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Odontogenic keratocyst
especially in the third molar region and ascending ramus n Symptoms: few, secondarily inflammed, enlarge predominantly in an antero-posterior direction
口腔颌面部囊肿 The cysts of oral region
郑州
大学
oral pathology
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口腔颌面部囊肿/学习要求
n 掌握：牙源性角化囊肿、含牙囊肿、萌出囊肿、 鼻腭管囊肿、腮裂囊肿、粘液囊肿及舌下囊肿 的病理变化。
n 熟悉：牙源性角化囊肿易复发的原因及组织来 源；含牙囊肿、鼻腭管囊肿、腮裂囊肿的组织 来源；粘液囊肿的发生过程。
n containing mucus-producing cells
n Crypt or cyst-like spaces within the thickness of epithelium
n Mucin may be demonstrable within the intraepithelial spaces and within the main cyst cavity
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含牙囊肿/病理
n 大体： n 镜下：
n A thin layer of connective tissue lined by epithelium that may be only two or three cells thick and this resemble the reduced enamel epithelium
epithelium
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含牙囊肿（dentigerous cyst，或滤泡囊肿）
concept: a cyst which encloses the crown and is attached to the neck of an unerupted tooth. It develops by accumulation of fluid between the reduced enamel epithelium and the crown,or between the layers of the reduced enamel epithelium
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Odontogenic keratocyst
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Odontogenic keratocyst
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Odontogenic keratocyst
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Odontogenic keratocyst
n 了解：口腔颌面部囊肿的分类；牙源性角化囊 肿、含牙囊肿、鼻腭管囊肿、腮裂囊肿、粘液 囊肿及舌下囊肿的临床表现。
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口腔颌面部囊肿/一般特点
n 囊肿的概念：含流体、半流体或气体的 病理性囊腔，多数囊肿有上皮衬里 假性囊肿： 与脓肿区别：
n 囊肿的一般病理学特点：囊腔(囊内容)、 囊壁(纤维结缔组织)、上皮衬里
in female
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dentigerous cyst
n Radiographically(有特点，但不能作为诊断依据) A well-defined radiolucent area associated with the crown of an unerupted tooth. Often the radiolucent area surrounds the crown, but sometimes it lies mainly or entirely to one side
n Epithelial plaque may be present
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腺牙源性囊肿/病理
The fibrous capsule is usually free from inflammatory cells
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腺牙源性囊肿/病理
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鼻腭管囊肿/病理
n Lined by stratefied squamous epithelium, pseudostratified ciliated columnar epithelium or both
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Odontogenic keratocyst(primordial cyst)
clinical features
n Age: second and third decades, fifth decades n Sex: more common in males than females n Location: 70-80% occur in the mandible,
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牙源性角化囊肿/病理
n 大体：囊壁薄，内容为清液或血性，可见角化物，蛋白含量：＜ 3.5g/100ml
n 镜下： 一、上皮： 1.复层鳞状上皮：无上皮钉突，有下皮下裂隙 2.上皮表面正角化或不全角化，呈波浪状 3.棘细胞层较薄，呈细胞内水肿 4.基底细胞呈栅栏状排列，核远离基底膜 二、囊壁：纤维囊壁较薄，子囊、上皮团、炎症 三、细胞增殖特点
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dentigerous cyst
n Location:mandibular third molar, the maxillary canine and third molar,and the mandibular second premolar(阻生牙区)
n Age:in the 2nd,3rd and 4th decades n Sex: more frequently in male than
人龈囊肿 2.缩余釉上皮：含牙囊肿，萌出囊肿和牙旁囊肿 3.Malassez上皮剩余：根尖囊肿，残余囊肿，根尖侧囊肿
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口腔颌面部囊肿/一般特点
临床： n 表现为瘤样病变 n 发生在颌骨者：膨大、乒乓球样感、囊
液常含胆固醇结晶，X线检查见透光区， 应与肿瘤鉴别 n 发生在软组织：部位对诊断重要 n 缓慢增大，无症状
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口腔颌面部囊肿/一般特点
分类： 一、颌骨囊肿：上皮性和非上皮性 (一)上皮性：
1.牙源性：发育性：牙源性角化囊肿，含牙囊肿，萌出囊肿，婴儿“龈囊肿”，
成人龈囊肿，发育性根侧囊肿，腺牙源性囊肿
炎症性：根尖囊肿，根尖侧囊肿，残余囊肿，牙旁囊肿
2.非牙源性：切牙管囊肿，鼻牙槽囊肿 (二)非上皮性：单纯性骨囊肿，动脉瘤性骨囊肿 二、颌骨外(软组织囊肿)
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Odontogenic keratocyst
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Odontogenic keratocyst
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牙源性角化囊肿/复发
复发倾向较其它囊肿高（5~62%） n 壁薄而脆，不易完整摘除 n 生长方式特殊 n 子囊和蕾状上皮团 n 与囊肿的上皮来源有关（上皮剩余、粘
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痣样基底细胞癌综合征
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Odontogenic keratocyst
pathogenisis n Dental lamina or its remnants n Offshoots of the basal layer of oral
n 可发生于骨内(切牙管)或骨外(切牙乳头) n Radiographically, the cyst is found in the
midline of the maxilla as a well-defined round,ovoid or heart-shaped radiolucency，切 牙窝深度6mm以下为正常，但超过无症状者观察。
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n Clinically, occur in the 4th,5th and 6th decades,and there is a three to one preponderance in males as compared to females
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腺牙源性囊肿/病理
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腺牙源性囊肿/病理
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鼻腭管囊肿/一般特点
n 鼻腭管囊肿(nasopalatine duct cyst) 也称切牙管囊肿(incisive canal cyst)
n A cyst arising from the epithelial residues in the nasopalatine (incisive) canal
皮样或表皮样囊肿，鳃裂囊肿，甲状舌管囊肿，畸胎样囊肿，粘液囊肿，舌下囊肿
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口腔颌面部囊肿/一般特点
牙源性：发育性：牙源性角化囊肿，含牙囊肿，萌出囊肿，婴儿“龈囊肿”，
成人龈囊肿，发育性根侧囊肿，腺牙源性囊肿
炎症性：根尖囊肿，根尖侧囊肿，残余囊肿，牙旁囊肿
囊肿不同，来源的残余上皮不同 1.Serres上皮剩余：牙源性角化囊肿，发育性根侧囊肿，婴儿“龈囊肿”，成
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腺牙源性囊肿/病理
epithelium：
n Stratified epithelium has a surface layer of acidophilic cuboidal or columnar cells, forming irregular papillary projections
n Ciliated epithelium