| Objective Cysts of the jaws are very common in clinical stomatology. Patients who suffered cysts of the jaws are not able to feel the disease in time because the symptoms are not very obvious at the onset, which would result in relatively severe bone defect. Therefore, the reparation of bone defect has been considered as ultimate goal of jaws’ cysts treatment. This study adopts fenestration and calcium sulfate implantation in the treatment of jaw cysts(especially odontogenic cysts, OKC), to investigate the curative effects. This study would provide the clinical validation for the application of calcium sulfate in bone defect repair.Methods This study chose26patients that have been infected with large and middle scale jaw cysts and accepted treatment in Anhui Stomatological Hospital from December2010to June2012. Orthopantomography(OPT) technology was used to measure cysts size before operation, and the analysis revealed the size ranged from3.0cm x2.0cm to8.0cm×3.0cm. All of the samples were divided into two groups and different treatment methods were designed for the two groups respectively. Group A with12samples:the size of cysts ranging from4.5cm×2.0cm to8.0cm×3.0cm; Group B with14samples:the size of cysts ranged from3.0cm×2.0cm to4.5cm x2.0cm. These patients were informed on the pros and cons of various treatment options through the preoperative conversations.12patients of group A agreed to take fenestration as conservative treatment at first, then underwent cysts curettage and calcium sulfate bone graft substitutes implantation while the cysts shrank down.14 cases of group B were treated by cysts curettage as radical surgery. Among them7cases adopt calcium sulphate plombage after cyst curettage. All patients were followed up6-24months, and clinical observation and X-ray examination were recorded for the further analysis. We observed patients’general condition and local cicatrization situation of fenestration, measured the effect of bone defect repairing, the absorption of calcium sulfate material by X-ray, and recorded and analyzed changes in the patients’ cyst area healing.Results All the26patients were followed up. Bone with defects caused by cysts oppression gradually repaired. Wound infection, pathological fracture, material rejection, jaw dysfunction and maxillofacial deformities after operation were not found during the follow-up period. During the period of fenestration, the flush of cysts were satisfied. Fenestration entrances were unblocked. No infection or obvious inflammation reaction was found. Cases with cysts curettage and calcium sulfate bone graft subtitutes implantation did not appear obvious inflammation or material rejection, only found swelling with the ipsi lateral facial which alleviated after timely and relatively effective treatment. The X-ray examination showed that the calcium sulfate bone graft substitutes were absorbed by one-half after1month of operation and totally after3months. The low density area was smaller in the original cysts cavity, and high density in the cysts increased significantly with fuzzy boundaries of cysts.6months after operation, there was no obvious difference in image density between the original cavity and normal bone, and the capsule cavity boundary disappeared, and defect area was full of new bone. As the control group without treatment using calcium sulphate after cysts curettage, postoperative bone with defect repaired at a slow pace. The X-ray examination showed that the original cysts low density image limited after3months of operation, the low density area was smaller in the original cysts cavity after6months of operation, and after12months the bone with defect repair at a large scale, and the original low-density image disappeared.Conclusions26patients’ jaw cysts were all cured. Bone with defects caused by cysts oppression were generally repaired. Treating large odontogenic cysts with fenestration has the advantages as less surgical trauma, protecting important blood vessels and nerves adjacent cysts, reducing the risk of postoperative pathologic fracture, saving the continuity and integrity of the mandible shape; Calcium sulfate material filled defect in the bone cavity after cysts curettage provide a space and conduction stents for the ingrowth of blood vessels and osteoblasts to ensure the continuity of the osteogenetic process. The degradation and absorption of calcium sulfate formed local slightly acidic environment and high calcium environment, which accelerated osteogenesis speed, boosted the osteogenic quality, reduced the possibility of cyst recurrence. Also repaired bone defects better and improved the quality of patients’ lives. |
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