Orçun TOPTAŞ, Timuçin BAYKUL, Müge ÇINA AKSOY, Gülperi KOÇER, Yavuz FINDIK

MANDİBULER RAMUS LEZYONLARININ CERRAHİ ZORLUKLARI

Amaç Çevresindeki vital dokular nedeniyle mandibula ramusuna yerleşmiş lezyonlara erişmek, mandibula korpusundaki lezyonlara ulaşmaktan daha zordur. Çalışmamızda Süleyman Demirel Üniversitesi Diş Hekimliği Fakültesi Ağız Diş Çene Hastalıkları ve Cerrahisi Ana Bilim Dalı'nda 2000-2011 yılları arasında tedavi edilen 22 kist ve tümör hastası ramusa ulaşım zorlukları açısından prospektif olarak incelenmiştir. Yöntem 19 hastaya enükleasyon ve küretaj uygulanırken iki hastaya marsüpyalizasyon ve dekompresyon uygulamasının ardından enükleasyon uygulanmıştır. Bir hasta ise ameloblastoma nedeniyle parsiyel rezeksiyonla tedavi edilmiştir. Sonuç Hastalarda en sık görülen komplikasyon sinir hasarı olarak belirlenmiştir. Ramus bölgesine yerleşmiş lezyonlarda, tomografik görüntüleme yöntemlerinden faydalanılması, bölgenin anatomik olarak çok iyi bilinmesi, insizyon ve giriş için kullanılacak işaret noktalarının direkt görülerek, palpe edilerek ya da en azından bir el aleti yardımıyla belirlenerek işlemin yapılması daha uygundur.

Anahtar Kelimeler:

Ramus, alt çene, küretaj, kist, ameloblastoma

Surgical Difficulties of Ramus Lesions

The mandible ramus lesions are more difficult to access in surgical procedures than mandible corpus lesions because of surrounding vital tissues of the mandible ramus. In our study, 22 patients with cysts and tumors who were treated between the years 2000-2011 at Suleyman Demirel University, Faculty of Dentistry, Oral and Maxillofacial Surgery Department, were examined prospectively in terms of transportation difficulties mandible ramus . 19 patients were treated with enucleation and curettage, enucleation was applied after the marsupialization and decompression treatment to the two patient. One patient was treated with partial resection because of the Ameloblastoma . Nerve damage after the surgery was identified as the most common complication in patients. In located ramus of lesions, utilization of the tomographic imaging methods and very good knowledge of the anatomical structure of the region or at least used a hand tool, make the process more convenient .

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Blanchaert RH, Ord RA. Vertical ramus compartment resection of the mandible for deeply invasive tumors. J Oral Maxillofac Surg. Jan 1998;56(1):15-22.
Isolan GR, Rowe R, Al-Mefty O. Microanatomy and surgical approaches to the infratemporal fossa: an anaglyphic three-dimensional stereoscopic printing study. Skull Base. Sep 2007;17(5):285-302.
Sun ZJ, Sun HL, Yang RL, et al. Aneurysmal bone cysts of the jaws. Int J Surg Pathol. Aug 2009;17(4):311-322.
Niedzielska I, Janic T, Mrowiec B. Low-grade myofibroblastic sarcoma of the mandible: a case report. J Med Case Reports. 2009;3:8458.
MÜDERRİS S, YILMAZ D. Mandibulada Bilateral Dev Odontojenik Keratokist ve Obliteratif Cerrahi Yaklaşım. Cumhuriyet Üniversitesi Dişhekimliği Fakültesi Dergisi. 1998;1(1).
Bataineh AB, al Qudah M. Treatment of mandibular odontogenic keratocysts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jul 1998;86(1):42-47.
Rapidis AD, Vallianatou D, Apostolidis C, et al. Large lytic lesion of the ascending ramus, the condyle, and the infratemporal region. J Oral Maxillofac Surg. Aug ;62(8):996-1001.
Meningaud JP, Oprean N, Pitak-Arnnop P, et al. Odontogenic cysts: a clinical study of 695 cases. J Oral Sci. Jun 2006;48(2):59-62.
Kim ST, Hu KS, Song WC, et al. Location of the mandibular canal and the topography of its neurovascular structures. J Craniofac Surg. May 2009;20(3):936-939.
Troulis MJ, Kaban LB. Endoscopic approach to the ramus/condyle unit: Clinical applications. J Oral Maxillofac Surg. May 2001;59(5):503-509.
Troulis MJ, Kaban LB. Endoscopic vertical ramus osteotomy: early clinical results. J Oral Maxillofac Surg. Jul 2004;62(7):824-828.
Trost O, Kazemi A, Cheynel N, et al. Spatial relationships between lingual nerve and mandibular ramus: original study method, clinical and educational applications. Surg Radiol Anat. Jul 2009;31(6):447-452.
Erdogmus S, Govsa F, Celik S. Anatomic position of the lingual nerve in the mandibular third molar region as potential risk factors for nerve palsy. J Craniofac Surg. Jan ;19(1):264-270. Ma J, Lu L. Computed tomography morphology of the mandibular ramus at the lingual plane in patients with mandibular hyperplasia. Int J Oral Maxillofac Surg. Aug ;38(8):823-826. Yu IH, Wong YK. Evaluation of mandibular anatomy related to sagittal split ramus osteotomy using 3- dimensional computed tomography scan images. Int J Oral Maxillofac Surg. Jun 2008;37(6):521-528.