个性化手术方案在口腔上颌窦瘘修复中的临床应用

目的探讨个性化手术方案在口腔上颌窦瘘修复中的应用疗效和意义。方法回顾性分析2006年5月~2013年9月我院手术治疗的31例口腔上颌窦瘘患者的临床资料。根据瘘孔的大小及边缘炎症情况、上颌窦内炎症程度选择不同的手术修复方法:对瘘孔直径7 mm的17例患者,采用双层组织瓣重叠修复:用龈粘骨膜瓣翻转缝合封闭瘘孔作为内层衬里,适度降低牙槽嵴后,用游离松解的颊、腭侧粘骨膜瓣覆盖于龈粘骨膜瓣上作为表层间断缝合。对瘘孔直径7~25 mm的9例患者,采用三层组织瓣重叠修复,即在双层组织瓣间夹用带血管蒂颊脂垫组织瓣。对瘘孔直径25 mm以上的5例患者,采用带血管蒂的全腭瓣或额瓣旋转覆盖瘘孔缝合修复。对患侧并发严重上颌窦炎的9例患者采用功能性鼻窦内窥镜术:经中鼻道上颌窦自然开口扩大开放、病灶清除引流术后再修复口腔上颌窦瘘孔。结果术后72 h去除口腔反包扎碘仿油纱后见切口边缘有白色假膜,术后第12 d拆除表层缝线切口无裂开。本组31例患者均获随访,时间1~6个月。采用双层组织瓣重叠修复法的1例小瘘孔患者复发,3个月后再手术行三层组织瓣重叠修复治愈;1例采用带血管蒂额瓣修复瘘孔的患者因皮瓣远端与软腭交界处缝合时有张力致术后缝线局部脱落,经碘仿砂条换药治愈;其余病例均一次性修复治愈。术中结合鼻窦内窥镜术的9例患者上颌窦炎均治愈。结论口腔上颌窦瘘的临床治疗应根据患者的不同病情选用相应的手术修复方法,可提高临床一次性治愈率。

Application of Individual Surgical Intervention for Repairing of Oroantral Fistula

Objective To explore the clinical application and value of personalized surgical treatment for repairing the oroantral fistula. Methods A total of 31 cases with oroantral fistula treated in our hospital from May 2006 to September 2009 were analyzed retrospectively. The individual surgical interventions were performed according to different situations as the size of fistula and inflammation of maxillary sinus. To repair the fistula with a diameter less than 7 mm （in 17 cases）, double-layer tissue flaps overlapping method was adopted： Covered the fistula with gingival mucosa tissue flap as inner lining; after moderately decreasing the alveolar ridge, covered the gingival mucosa tissue flap with free and loosened buccal and palatal mucosa flap as surface microstructure tissue and sutured it discontinuously. To repair the fistula with a diameter during 7 to 25 mm （in 9 cases）, three-tier tissue flaps overlapping method was adopted： buecal fat pad with vascular pediele was clipped between the doub- le-layer tissue flaps. To repair the fistula with a diameter more than 25 mm （ in 5 cases）, pedicled whole-palatal flap or forehead flap was transferred to cover the fistula. Patients with serious maxillary sinusitis were received functional nasal endoscopic operation to broaden the natural opening of middle nasal meatus for drainage. Results White accidental membrane was formed in edge of incision 72 hours after the operation, and no wound dehiscence was occurred after stitch removal at day 12 after the operation. All 31 cases were followed up for 1 to 6 months. One patient treated with double-layer tissue flaps overlapping method was relapsed and cured by re-operation of three-tier tissue flaps overlapping method in period ]1 3 months afterwards, and an- other one case was found partial sutures exfoliated due to tension suturing and cured by change of dressing. The other cases were achieved well cured by one-time operation. The 9 patients combined with maxillary si- nusitis were cured by operation assisted