Case 1: a 15-year-old boy complained of a swelling in the left mandible. The diagnosis of follicular cyst was confirmed by orthopantomography . The entire cyst wall with a buried tooth (the 7th molar) was removed completely.
Case 2: an 11-year-old boy had multiple follicular cysts, a rare condition. One was in the left maxillary region and the other two cysts in the left mandible . The patient noted swelling of the left cheek. Orthopantomography and CT scans showed that the 7th tooth in the maxilla and the 4th and 7th teeth in the mandible were burried in cysts, the latter in a large cyst of the ramus. The 3 cysts containing the 3 teeth were totally removed.
The literature describing follicular cysts of the maxilla and mandible is reviewed.

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は,顎骨嚢胞の中でも比較的良く遭遇するが,年齢的に若年者に好発し,発生部位については,下顎智歯部,上顎前歯部,下顎小臼歯部の順に多く,上顎洞内に発生することは稀である。今回,われわれは,小児の上顎洞内に巨大なを認めた症例を経験したので報告する。
患者は13歳の女児。歯科治療目的で通院中の近隣歯科医にて,上顎左側第二大臼歯の抜髄処置を受けたところ,生活歯であったにもかかわらず,抜髄後の根管からの排膿を認めた。同歯科医にて根管内洗浄を続け,一時的に症状軽快していたが,抜髄処置より約二か月後,左側頬部腫脹,開口障害が出現したため,当科に紹介され来院した。歯性上顎洞炎の臨床診断にて,原因歯と思われる上顎左側第二大臼歯を抜歯したが,抜歯窩の治癒が不良で,同部の上顎洞口腔瘻孔が消失しなかった。そこで,二か月後に,瘻孔閉鎖術,上顎洞根治術,およびパノラマエックス線写真で確認していた上顎左側埋伏智歯の抜歯術を目的として,全身麻酔下に手術を施行したところ,左側上顎洞内に智歯由来の上顎洞を充満するほどの巨大なを確認したので,これを摘出した。

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Dentigerous cysts are developmental cysts. The pathogenesis of dentigerous cysts remains unknown; however some literature attribute the origin to degenerative changes in the reduced enamel epithelium following completion of the crown. Dentigerous cysts commonly occur unilaterally associated with the crown of permanent teeth. We report a case of dentigerous cysts occurring in mandible bilaterally in a 10-year-old-girl. A panoramic radiograph showed a well-defined radiolucent lesion that includes the crowns of unerupted bilateral mandibular second premolars under deciduos second molars. Computed tomography (CT) showed buccal cortical thinning and displacement of intra alveolar canal. Under general anesthesia, the cysts enucleated considering the preservation of involved permanent teeth. One year follow-up visit showed correct eruption of the teeth and stable occlusion.

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This is a case study reporting follicular cyst with odontoma of the cyst wall in a deciduous tooth.
The patient was a three-year-old boy who had been referred to us in Febrfary 1991 with delayed eruption of the E tooth.
The first set of teeth except the E tooth of this patient had completely erupted by the age of two years and six months, and as the E tooth had not appeared at the age of three he was reterred to us for examination.There were no subjective symtoms except the unerupted tooth
Extraoral observations showed no asymmetry of the face, swelling, or pain upon pressure.Intraorally, all the first teeth except E were erupted.An X-ray examination showed the E tooth to be in the vicinity of the body of the mandible and that the tooth crown was surrounded by a thumb-sized radiolucent area and at the distal part of the top of the X-ray image there was a 5 mm irregularly shaped X-ray opaque lump.The tooth root was complete but short and thin.No tooth germ for the 5 and 5teeth could be established.
Based on a clinical diagnosis of odontoma with follicular cyst, marsupialization under general anesthetics was performed in July 1991.At present, two years after the operation, the E tooth has completely erupted and is functioning normally.

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The dentigerous cyst is defined as a cyst arising from the retention of fluid between the recessed enamel epithelium and the crown of an unerupted tooth within the jaw, and then developing around its crown. It is classified as a developmental cyst by W. H. O. But since the permanent teeth are forming during childhood, we surmised that the development of dentigerous cysts may be associated with dental caries and periapical lesions of deciduous teeth.
To clarify the pathogenesis of the dentigerous cyst, the authors investigated 28 cases of dentigerous cysts in children, with special regard to the clinical and pathological findings. The results were as follows.
The ages of the patients were concentrated around the area of 10 years old. About 60% of the cysts occurred in the lower molar region and the characteristic findings were asymptomatic swelling in the alveolar region. In 22 cases, root canal treatment was performed on the primary predecessors. In 3 cases, the primary predecessors were affected and non vital. Pathological findings in all cases confirmed the presence of inflammation of the connective tissue of the cyst wall.
These results suggest that one of the pathogenetic factors in the occurrence of dentigerous cysts is inflammation caused by the periapical lesion of deciduous teeth.
18 cases were treated by marsupialization or extirpation after preoperative treatment using the irrigation method. The irrigation method was effective in reducing the size of the cyst cavity. Cyst cavity size and tooth axis influenced the eruption of permanent teeth after marsupialization. We considered that in cases where eruption is likely to be difficult, early orthodontic treatment is desirable.

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1984年から1990年までの6年間に,九州大学歯学部附属病院小児歯科外来において含歯性嚢胞と診断された4歳10カ月から14歳10カ月までの小児16例を経験した.発見時の平均年齢は約10歳であり,男児に多く認められた.発見の機会は,無痛性の顎骨や歯肉の腫脹によるものが最も多く,次いで定期診査時に偶然発見されたものであった.発症部位は,25歯のうち,下顎第1小臼歯が12歯および下顎第2小臼歯が10歯であった.
先行乳歯は,不明歯2歯を除き,すべてが何等かの齲蝕処置を受けた経験があり,23歯中21歯が,Hellmanの発育段階II A期からII C期にかけて歯髄処置ならびに歯冠修復処置を受けていた.それらの処置経過の判明した症例では,ほとんどが処置後3年から6年経過時のIII B期に嚢胞の発症をみた.このことからも,定期診査の重要性が示唆された.
術前の歯列咬合診査により,咬合誘導の観点から,自然萌出を期待する症例,保隙処置が必要な症例,および動的咬合誘導が必要な症例の3群に,先行乳歯の抜去と嚢胞の開窓後の治療方針を分けた.現在も経過観察中の2例および本学歯科矯正科紹介の1例を除き,いずれの歯も歯列内の正常位置へ萌出誘導することができた.

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Dentigerous cysts are the most common odontogenic jaw cysts in children. However, multiple dentigerous cysts in nonsyndromic children are rare. We described a case of dentigerous cysts of the second premolor teeth in both jaws of a 10-year-old boy. Marsupialization of the cysts was performed. There has been no recurrence about two years after the surgical treatment.

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昭和49年から57年までの9年間に,岩手医大歯学部小児歯科外来において臨床的に顎骨嚢胞と思われた5歳1ヵ月から12歳4ヵ月までの小児17例を経験した.全症例に歯肉,歯槽粘膜部の腫脹を認めたが,ほとんどが無痛性のため,顔面へ腫脹を来たしてから,または定期診査で発見されたものが多かった.
臨床所見ならびにX線写真像では,すでに先行乳歯が抜歯されている2例を除いて,嚢胞内に乳歯の歯根ならびに後継永久歯歯胚が包含されていた.さらに,後継永久歯周囲のX線透過像の巾は3mm以上で,その境界は明瞭であった.ほとんどの症例で,帯黄色の内溶液が確認された.発生部位は下顎第2小臼歯すなわち先行乳歯が第2乳臼歯である部位が最も多く,次いで,上顎前歯部であった.また,先行乳歯は歯髄処置の既往のあるものや感染根管を有するものであり,歯髄処置の行なわれている乳歯の歯根には異常吸収が認められた.さらに,病理組織診断の得られた症例でも,この嚢胞が乳歯根尖病巣の影響によることが認められた.したがって,本症例群の顎骨嚢胞の病因は,乳歯根尖病巣が考えられると同時に,乳歯の歯髄処置の重要性が考えられた.処置方法は,大部分の症例に開窓療法を行ない,嚢胞の縮小と未萌出の後継永久歯を正常位置へ萌出,誘導することができた.

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昭和53年4月より昭和63年12月までの約11年間に本院歯科・口腔外科を受診し, 顎骨嚢胞と診断され治療した159例について臨床統計的観察を行い以下の知見を得た.
最も多く認められたのは歯根嚢胞で99例(62.3%), 次いで術後性上顎嚢胞29例(18.2%), 以下, 15例(9.4%), 顔裂性嚢胞8例(5.0%), 類表皮嚢胞3例(1.9%)などであった. 歯原性嚢胞と非歯原性嚢胞の発現率は2.9:1で歯牙に由来する嚢胞が非歯原性嚢胞の約3倍であった. さらに, 歯根嚢胞とにおいては, 6.6:1の発現率を示していた.
主訴別症例数については, 腫脹72例(36.9%)で最も多く, 次いで腫脹および疼痛37例(19.0%), 違和感23例(11.8%),疼痛19例(9.7%)などの順であり, これら4群の合計は151例(77.4%)であった.

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著者らは,3部に集合性歯牙腫とが相接して発生していた珍しい症例に遭遇した。患者は,11歳の女児で,3の萌出遅延と同部歯肉の膨隆を主訴として来院した。口腔内は3が未萌出で,同歯肉部に骨様硬の腫脹がみられた。X線診査により3歯胚は,2と4間に埋伏し,歯冠部を中心に境界明瞭な類円形のX線透過像を認めた。また,その歯冠尖端部付近に,数個のX線不透過像が重なりあうようにして存在していた。処置は全身麻酔のもとに,3歯胚および集合性歯牙腫とを摘出した。摘出物は光顕的並びに電顕的検索を行った。術後1 年4 カ月を経過したが, 摘出物の歯周組織には何ら異常はなく,X線像では,骨創部は新生骨によって満たされ,漸時,正常な骨構造に回復している。

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In the past five years, we performed 26 cases of marsupialization on follicular dental cysts in 23 children. We reported the results of the marsupialization after a clinical examination of the cases.
The inclination of the tooth axis improved remarkably only applying the treatment.
In addition, eruption of teeth which had been delayed due to a cyst was promoted by the concerted effect of the operation and orthodontic treatment.
Twenty three out of 26 cases erupted, although 20% of the 23 did not come out in the normal dentition.
These results indicating the effectiveness of preserving infant permanent teeth which is formed under a follicular dental cyst.

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Follicular dental cyst is not uncommon among odontogenic cyst, but bilateral follicular dental cyst is considered to be rare.
The authors experienced a case of bilateral follicular dental cyst of 5_??_5, on which a report was made here with literature consideration thereof.
The patient, a 12-year-old, noticed a swelling of the right mandibular body, was pointed out cystlike radiolucent areas containing the impacted 5_??_5 on a dental caries treatment. She then visited our department. On rentgenographic examination, radiolucent areas were noted with a comparatively clear border containing the crown of these 5_??_5, therefor the lesions were diagnosed follicular dental cyst. Under general anesthesia, complete extirpation of the cyst by extraction 5_??_ and treatment of Partsch I method to _??_5 were done. Histopathologically, the extirpated cyst walls of 5_??_5 were covered by stratified squamous epithelium overlying. a connective tissue_ and were diagnosed as dentigerous cyst.

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We encountered a case of a dentigerous cyst with odontoma in a 12-year-old boy. The cyst included the crown of an impacted permanent tooth. Based on a clinical diagnosis of dentigerous cyst with odontoma, marsupialization under local anesthesia was performed. The odontoma was removed and the deciduous tooth was extracted to facilitate orthodontic treament. One year and two months after the operation, the impacted permanent tooth has completely erupted and is functioning normally.

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1 9 8 6 年6 月から1 9 8 8 年4 月までの約2 年間に, 徳島大学歯学部附属病院において,含歯性嚢胞と診断された小児10名11例を経験し,全症例に対して可及的嚢胞壁摘出法および舌側弧線装置による保隙を行い,その治癒経過について検討した。
経過観察期間は,最長28カ月,最短6カ月,平均15.9カ月であった。性差があり,男児に多く認められた。発見時の年齢は9歳が最も多く,HellmanのDental age III Aと III Bに集中していた。発現部位は,下顎第2小臼歯に最も多く認められた。先行乳歯は,すでに抜歯されていたり, 残根状態であった2 例を除いて, 健全であったものは上顎に認められた1例のみで,他はすべて歯髄処澱の既往があった。オルソパントモX線写真上の嚢胞の大きさは, 近遠心径が1 5 m m-3 5 m m のものが9 例, 5 0 m m - 5 5 m m のものが2 例であった。嚢胞内永久歯の状態は,遠心偏位,近心偏位,頬側傾斜,偏位傾斜なしの4タイプが認められ,遠心偏位のものが術後の永久歯胚の萌出速度が最も速いことが認められた。治癒の早さは従来の開窓法と比べ, 嚢胞消失までは早く, 嚢胞内永久歯の萌出はやや遅かった。全例とも嚢胞が消失し,しかも11例中8例は,矯正治療の必要なく嚢胞内永久歯を,正常な歯列内に萌出させることができた。したがって,小児における含歯性嚢胞の処置として,可及的嚢胞壁摘出法と舌側弧線による保隙装置の併用法はきわめて有効であることが認められた。

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