치성각화성낭종 (Odontogenic Keratocyst)환자의 치험례 = ODONTOGENIC KERATOCYST OF A FEMALE CHILD, A CASE REPORT

국문 초록 (Abstract)

치성각화성낭종(Odontogenic keratocyst. OKC)은 치체(dental lamina)로부터 발생하는데，모든 악골 낭의 5~17% 정도를 차지하며 낭의 내부는 이장상피로부터 유래한 점액성이나 치즈양 물질인 케라틴(keratin)으로 채워져 있다. 치성낭 중 가장 높은 재발률을 보인다는 것이 이 낭의 중요한 특정이다. 간혹 기저층에서 인접 결체조직 벽으로 돌기가 증식하기도 하며 결체조직 벽 내에 존재하는 치성 상피조직 섬의 증식이 위성 소낭을 발생시키기도 한다. 이들 소낭들이 치성각화성낭종의 높은 재발률의 원인으로 여겨진다.
치성각화성낭종은 다양한 연령층에서 발견되나, 20대와 30대에서 호발한다. 남성에서 다소 호발하며 하악，특히 제3대구치와 하악지 부위에서 자주 발생한다. 대개 피질골의 팽융에 의해 처음 발견되며 매복치와 관련되어 있고 일반적으로는 증상이 없지만 동통과 감염이 나타날 수도 있다. 흡인시 걸쭉한 노란 치즈양 물질인 케라틴이 관찰되며 특히 재발이 잘 된다.
치성 각화낭의 중요한 특징 중의 하나는 병소가 피질골의 팽창을 많이 유발시키지 않으면서 악골의 내면을 따라 성장한다는 것이다. 치성각화성낭종화낭은 인접 치아를 변위시키고 흡수사킬 수 있으나 함치성낭보다는 정도가 심하지 않다. 하악관을 하방으로 변위시키기도 하며 상악 병소의 경우는 상악동을 침범해서 상악동 전체를 차지하기도 한다.
본 증례는 7세 10개월 된 여아의 하악 우측 제2유구치 부위에 발생한 치성각화성낭종에 대한 증례로써 전신마취하 낭종적출술을 시행하였다. 낭종에 포함된 제1.2유구치，유견치 및 제1소구치 치배를 발거하였으며，현재 공간유지장치를 장착후 주기적으로 내원중이다.

다국어 초록 (Multilingual Abstract)

Odontogenic keratocyst is classified as a developmental odontogenic cyst and is believed to arise from cell rests of the dental lamina. It accounts for 3% to 11% of all jaw cysts and they occur twice as often in the mandible as in the maxilla. Histologically, the cysts are lined by stratified, keratinizing, squamous epithelium. Daugther cysts or microcysts are often observed microscopically. The recurrence rate has been reported variously, but is known by its high recurrence rate.
These lesions are more common in males than in females, occur over a wide age range and are typically diagnosed during the 2nd and 3rd decade. The diagnosis depends on the cyst's microscopic features and is independent of its location and radiographic appearances. This cyst is a radiolucent lesion that is often multiloculated, has a smooth or scalloped border. The cyst is characteristically located in the body and ramus of the mandible, and often occurs in conjunction with an impacted tooth.
This case report describes an odontogenic keratocyst on the lower right molar area of an 8-year-old girl. The cyst was removed under the general anaesthesia, and is being checked regularly for any recurrences.

참고문헌 (Reference)

1 Marker P, "Treatment of large odontogenic keraocyts by decompression and later cystectomy. A long-term follow-up and a histologic study of 23 cases" 82 : 122-131, 1996

2 Gardner DG, "The treatment of ameloblastoma based on patholgic and anatomic principles" 46 : 251-259, 1980

3 Garlock JA, "The odontogenic keratocyst" 85 : 452-456, 1998

4 Voorsmit RACA, "The incredible keratocyst: a new approach to treatment" 40 : 621-624, 1985

5 Van der Linden FP, "The development of the human dentition" 53 : 17-31, 1985

6 Bradley PF, "The cryosurgery of bone. An experimental and clinical assessment" 13 : 111-127, 1975

7 Blanas N, "Systemic review of the treatment and prognosis of the odontogenic keratocyst" 90 : 553-558, 2000

8 Pindborg JJ, "Studies on odontogenic cyst epithelium 2: clinical and roentgenological aspects of odontogenic keratocysts" 58 : 283-294, 1963

9 Scharffetter K, "Proliferation kinetics-study of the grwoth of keratocysts" 17 : 226-233, 1989

10 Philipsen HP, "Om Keratocyster I kaeberbe" 60 : 963-980, 1956

11 Zachariades N, "Odontogenic keratocysts: review of the literature and report of 16 cases" 43 : 177-182, 1985

12 Kondell PA, "Odontogenic keratocysts: a follow-up study of 29 cases" 12 : 57-62, 1988

13 Myoung H, "Odontogenic keratocyst: Review of 256 cases for recurrence and clinicopatholigic parameters" 91 : 328-333, 2001

14 Chow HT, "Odontogenic keratocyst : A clinical experience in Singapore" 86 : 573-577, 1998

15 Yoshiura K, "Morphologic analysis of odontogenic cysts with computed tomography" 83 : 712-718, 1997

16 Irvine GH, "Mandibular keratocyts: surgical management" 23 : 204-209, 1985

17 Ljubenovic M, "Gorlin- Goltz syndrome" 16 : 166-169, 2007

18 Main DMG, "Epithelial jaw cyst: 10 years of he WHO classification" 14 : 1-7, 1985

19 Payne TF, "An analysis of the clinical and histologic parameters of OKC" 33 : 536-546, 1972

20 Woolgar JA, "A comparative study of the clinical and histological features of recurrent and non-recurrent odontogenic keratocysts" 16 : 124-128, 1987

21 Woolgar JA, "A comaparative study of the clinical and histological features of recurrent and non-recurrent odontogenic keratocysts" 16 : 124-128, 1987

22 Morgan TA, "A Restrospective Review of Treatment of the Odontogenic Keratocyst" 63 : 635-639, 2005