儿童下颌第二磨牙冠周炎致下颌骨骨髓炎的临床诊治

目的:探讨儿童下颌第二磨牙冠周炎导致下颌骨骨髓炎的临床特点及治疗方法。方法:选取2016年1月~2019年3月共收治10例儿童下颌第二磨牙冠周炎致下颌骨骨髓炎患者,平均年龄12.1岁,临床表现为面部肿胀、发硬、张口受限。10例患者均在全麻下行“下颌骨骨髓炎探查刮治活检术+冠周龈瓣切除术”,预防性“拔除下颌第三磨牙胚”。病变发生于下颌体、下颌角及下颌升支,以颊侧为主,9例出现骨质破坏,10例病例可见较广泛的骨质增生硬化、与颌骨平行的骨膜新生骨。结果:10例患者术后口内创口均愈合良好,面部肿胀消退,张口度改善,3月后复查锥形束CT显示骨质缺损区范围逐渐缩小,病变颌骨可重新塑形解剖结构接近正常。结论:儿童下颌第二磨牙冠周炎所致下颌骨骨髓炎患者的发生年龄小,早期诊断与治疗有助于防止下颌骨破坏加重,避免下颌骨发育畸形、病理性骨折及面部畸形;对于以颊侧病变为主的骨髓炎病灶,经口内切口彻底行下颌骨骨髓炎刮治术取得良好的临床治疗效果。

Diagnosis and Treatment of Mandibular Osteomyelitis Caused by Pericoronitis of Mandibular Second Molars in Chil-dren

Objective:To investigate the clinical characteristics and treatment of mandibular osteomyelitis caused by pericoronitis of the second molar in children.Methods:From January 2016 to March 2019,a total of 10 children with osteomyelitis of mandible caused by pericoronitis of mandibular second molars were admitted and treated.The average age was 12.1 years old,and the clinical manifestations were facial swelling,stiffness,and limited mouth opening.All 10 patients underwent"mandibular osteomyelitis exploration and curettage biopsy and pericoronal gingival flap resection"under general anesthesia to prevent"extraction of mandibular third molars".The lesions occurred in mandibular body,mandibular angle and ascending ramus,mainly in buccal side.Bone destruction was observed in 9 cases.Extensive osteosclerosis with periosteal new bone parallel to the jaw bone was seen in 10 cases.Results:All 10 patients had good postoperative oral wound healing.The facial swelling subsided and mouth opening improved.The CBCT reexamination 3 months later showed that the area of bone defect was gradually reduced,and the anatomical structure of the diseased jaw could be reshaped close to normal.Conclusion:The patients with mandibular osteomyelitis caused by pericoronitis of mandibular second molars generally are children.Early diagnosis and treatment are helpful to prevent the destruction and aggravation of mandible and to avoid mandible developmental malformation,pathological fracture,and facial malformation.Curettage of mandibular osteomyelitis through an internal incision can achieve good clinical results for the lesions of buccal lesions.