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1、口腔颌面部囊肿The cysts of oral region oral pathology郑州 大学2024/9/111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。2024/9/112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
2、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2024/9/113口腔颌面部囊肿/一般病理特点wallepithelial liningcavity2024/9/114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2024/9/115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
3、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) 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2024/9/116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 2024/9/1
4、17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2024/9/118Odontogenic keratocyst(primordial cyst)nAge: second and third decades, fifth decadesnSex: more common in males than femalesnLocation: 70-80% occur in the mandible, especially in the third molar regio
5、n and ascending ramusnSymptoms: few, secondarily inflammed, enlarge predominantly in an antero-posterior directionclinical features2024/9/119Odontogenic keratocystnUnilocular or multilocular patternnA smooth or scalloped borderradiographic features2024/9/1110Odontogenic keratocyst2024/9/1111牙源性角化囊肿/
6、病理ng/100mln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2024/9/1112Odontogenic keratocyst2024/9/1113Odontogenic keratocyst2024/9/1114Odontogenic keratocyst2024/9/1115Odontogenic keratocyst2024/9/1116Odontogenic keratocyst2024/9/11
7、17Odontogenic keratocyst2024/9/1118Odontogenic keratocyst2024/9/1119Odontogenic keratocyst2024/9/1120Odontogenic keratocyst2024/9/1121Odontogenic keratocyst2024/9/1122牙源性角化囊肿/复发复发倾向较其它囊肿高（562%）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、粘膜基底细胞）2024/9/1123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 c
8、arcinoma 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2024/9/1124痣样基底细胞癌综合征2024/9/1125Odontogenic keratocystpathogenisisnDental lamina or its remnantsnOffshoots of the basal layer of oral epithelium2024/9/1126含牙囊肿（dentigerous cyst，或滤泡囊肿） concept: a cyst which encloses th
9、e 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 epithelium2024/9/1127dentigerous cystnLocation:mandibular third molar, the maxillary canine and third molar,
10、and the mandibular second premolar(阻生牙区)nAge:in the 2nd,3rd and 4th decadesnSex: more frequently in male than in female2024/9/1128dentigerous cystnRadiographically(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
11、 crown, but sometimes it lies mainly or entirely to one side2024/9/11292024/9/1130含牙囊肿/病理n大体：n镜下：nA thin layer of connective tissue lined by epithelium that may be only two or three cells thick and this resemble the reduced enamel epitheliumnMucus-producing cells, ciliated cellsnKeratinization in li
12、mited areas2024/9/11312024/9/11322024/9/1133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。2024/9/1134腺牙源性囊肿/一般特点nglandular 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2024/9/1135腺牙源性囊肿/病理epithelium：nStratified epithelium has a surface layer of
13、 acidophilic cuboidal or columnar cells, forming irregular papillary projectionsnCiliated epithelium ncontaining mucus-producing cellsnCrypt or cyst-like spaces within the thickness of epitheliumnMucin may be demonstrable within the intraepithelial spaces and within the main cyst cavitynEpithelial p
14、laque may be present2024/9/1136腺牙源性囊肿/病理The fibrous capsule is usually free from inflammatory cells2024/9/1137腺牙源性囊肿/病理2024/9/1138腺牙源性囊肿/病理2024/9/1139腺牙源性囊肿/病理2024/9/1140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)nA cyst arising from the epithelial residues in the nasopalati
15、ne (incisive) canal2024/9/1141鼻腭管囊肿/一般特点nClinically, occur in the 4th,5th and 6th decades,and there is a three to one preponderance in males as compared to femalesn可发生于骨内(切牙管)或骨外(切牙乳头)nRadiographically, the cyst is found in the midline of the maxilla as a well-defined round,ovoid or heart-shaped rad
16、iolucency，切牙窝深度6mm以下为正常，但超过无症状者观察。2024/9/1142鼻腭管囊肿/病理nLined by stratefied squamous epithelium, pseudostratified ciliated columnar epithelium or bothnThe connective tissue wall contains large nerves and vessels; mucous glands and adipose tissue may also be present2024/9/1143鼻腭管囊肿/病理2024/9/1144腮裂囊肿/一般
17、特点nBranchial cleft cyst or cervical lymphoepithelial cyst 来源于腮裂上皮残余，或颈淋巴结异位涎腺上皮n青少年发病n部位：下颌角以上(第一鳃裂来源)；肩胛舌骨肌以上(第二鳃裂来源)；颈根区(第三、四鳃裂来源)； 其他部位者如口腔内(淋巴上皮囊肿)n界清、活动、增大缓慢、无症状2024/9/1145腮裂囊肿/病理n大体：囊内容物为黄绿或棕色清亮液体，或脓稠胶样、粘液样n镜下：复层鳞状上皮 纤维囊壁内含大量淋巴样组织， 形成淋巴滤泡。n恶变：淋巴上皮癌2024/9/11462024/9/1147腮裂囊肿/病理/淋巴上皮囊肿2024/9/1148粘液囊肿粘液囊肿（mucocele）临床：部位，多见下唇粘膜。 大小不一，呈淡蓝兰色 易破溃，易复发分类：外渗性，特点是无衬里上皮 潴留性，有上皮衬里2024/9/11492024/9/1150粘液囊肿（mucocele）/外渗2024/9/1151粘液囊肿（mucocele）/潴留2024/9/11522024/9/1153
