감압술을 이용한 치근단 낭의 처치
TREATMENT OF RADICULAR CYST USING DECOMPRESSION
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치근단 낭은 염증 등에 의한 자극으로 치수가 실활되어 치근단에 있는 상피로부터 형성되는 낭종으로 주된 기원은 말라세즈 상피잔사이지만 치은열구 상피나 상악동 이장 상피, 누공의 상피에 의한 것도 보고 되었다. 구강악안면 영역에서 가장 흔히 발생되는 낭종의 하나이지만 유치열기에서의 발생 빈도는 낮은 것으로 알려져 있다. 악골 내의 치성 낭종은 크기가 커지면서 주위 조직의 파괴나 구조의 변형을 초래할 수 있으며 유치의 경우에서는 후속 영구치배의 변위를 유발할 수 있다. 이런 큰 크기의 치성 낭종을 외과적으로 제거하면 해부학적 구조의 손상 및 안모의 변형, 치아흡수, 신경손상 등의 후유증을 일으킬 수 있으므로 조대술이나 감압술 후 적출하는 술식이 권장되고 있다. 이 증례는 하악 우측 부위의 동통을 주소로 연세대학교 치과대학병원 소아치과에 내원한 8세 남아로, 임상 및 방사선학적검사 결과 치수치료 후 기성금속관의 수복을 시행한 하악 우측 제1유구치의 치근단 하방에 방사선투과성 병변과 견치와 제1소구치의 변위를 발견하였다. 병소가 있는 하악 우측 제1유구치를 발거하였고, 조직학적 검사에서 치근단 낭으로 진단되었다. 감압술 및 공간유지장치를 시행하고 병소의 크기 변화와 하악 우측 견치와 제1소구치의 맹출 양상을 정기적으로 관찰한결과 양호한 치유 양상과 정상적인 맹출을 보였기에 이를 보고하고자 한다.
Abstract
Radicular cyst is a true epithelium lined cyst formed when epithelium at the apex of a nonvital tooth is stimulatedby inflammation. It is the most common type of cyst in the oral cavity, but its frequency is low in the primarydentition. Treatment of large-sized cyst aims at conservation of adjacent structure and allowance of proper eruption ofthe successive permanent teeth in the primary dentition. Considering these two aspects, marsupialization orenucleation following decompression is recommended as a treatment means for large-sized radicular cyst. In this case, 8-year old boy visited the pediatric dentistry department, Yonsei University Dental Hospital,with the chief complaint of pain on the lower right area. Clinical and radiographic examinations revealed periapicalradiolucent lesion on #84, which had previous pulp treatment and restorated with the stainless steelcrown. Dislocation of its successive tooth, #44, was also observed. #84 was extracted and sent for biopsy. Through histologic examination, it was diagnosed as radicular cyst. Following its extraction, removable spacemaintainer was delivered, which was also used as a decompressor. During periodic check-up for next 22months, favorable healing of the lesion and eruption of the successive tooth were observed.
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