Rana rekonstrukcija defekta vilice nastalog posle prve operacije velikog keratocističnog odontogenog tumora
Sažetak
Uvod. Keratocistični odontogeni tumor (KCOT) definisan je kao benigna cistična neoplazma viličnih kostiju odontogenog porekla, sa visokom stopom recidiva. Najveći broj lezija obuhvata bočne delove mandibule. Lečenje KCOT je kontroverzno, ali ciljevi lečenja treba da obuhvate eliminisanje potenecijala za pojavu recidiva, kao i smanjenje pojave hirurških komplikacija. Međutim, drugi značajan terapijski problem u lečenju KCOT jeste adekvatna i što ranija rekonstrukcija postojećeg viličnog defekta, kao i odgovarajuća estetska i funkcionalna rehabilitacija ovih bolesnika, naročito u slučajevima velikih destrukcija viličnih kostiju. Prikaz bolesnika. U radu je prikazana 65-godišnja žena sa veoma velikim KCOT mandibule. Na ortopantomografskoj radiografiji uočeno je elipsasto multilokularno rasvetljenje lokalizovano na desnoj strani tela mandibule i susednog dela ramusa donje vilice sa radiografski evidentnim postojanjem kortikalne perforacije prednje ivice ramusa i gornje ivice alveolarnog dela mandibule. Operativni zahvat izveden je u dve faze. U prvoj fazi, tumor je uklonjen enukleacijom uz upotrebu Karnojevog rastvora i perifernom osteotomijom, sa ekscizijom okolno zahvaćene sluzokože. U drugoj fazi, šest meseci kasnije, rekonstruiran je postojeći defekt donje vilice. Postoperativno, nije registrovana nikakva komplikacija niti pojava recidiva dve godine nakon intervencije. Zaključak. Adekvatna i rana rekonstrukcija postojećeg viličnog defekta i odgovarajuća estetska i funkcionalna rehabilitacija ovih bolesnika treba da bude primaran cilj lečenja KCOT. Takođe, potrebno je sistematsko i dugotrajno postoperativno praćenje bolesnika.
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