经鼻内镜开窗术治疗侵犯上颌窦的大型上颌骨囊性病变

目的 探讨经鼻内镜开窗术治疗侵入上颌窦的大型牙源性上颌骨囊性病变的应用价值。方法：对21例侵犯上颌窦的牙源性颌骨囊性病变（直径3.5~6 cm）患者行经鼻内镜开窗术, 术后通过临床检查、鼻内镜及CT检查随访1.5~3 a。结果：3个月内,面部恢复对称,鼻塞等症状消失。3个月后,鼻内镜下检查见鼻开窗口边缘的囊壁残缘与鼻底黏膜自然愈合,开窗口呈不同程度的缩小。CT复查发现,上颌窦与囊性病变融为一体。囊壁回缩,囊腔破坏的骨质出现再生,12个月后改建成接近正常的上颌窦。所有患者囊性病变未复发。结论：经鼻内镜开窗术是治疗侵入上颌窦的大型牙源性上颌骨囊性病变的有效方法。     

上颌窦黏膜囊肿鼻内镜下摘除同期窦底提升术初探

目的 评价鼻内镜下上颌窦黏膜囊肿摘除同期窦底提升术的临床效果。方法 2020年9月至2021年9月行上颌窦底提升患者9人，患者同时合并患侧上颌窦囊肿，在鼻内镜下行囊肿摘除术，并同期行窦底提升术，同期或二期植入种植体。结果 所有患者均在鼻内镜下行上颌窦黏膜囊肿摘除术及窦底提升术。2例患者同期植入种植体。术后6个月复查，上颌窦底提升植骨区无感染，同期植入种植体患者骨结合良好。所有患者上颌窦黏膜囊肿未复发，上颌窦黏膜愈合良好，2例手术中上颌窦底黏膜破裂的患者术后表现为上颌窦黏膜局部增厚，没有出现鼻窦炎症状。结论 鼻内镜下行上颌窦黏膜囊肿摘除同期行窦底提升术是安全可靠的。     

开窗减压术联合囊肿塞在颌骨囊肿治疗中的应用

目的:探讨开窗减压术联合囊肿塞在颌骨囊肿治疗中的应用,并评价其疗效。方法:对35例较大颌骨囊肿患者采用开窗减压术,吸除囊内容物,保留其余囊壁,制作囊肿塞,维持囊肿造瘘口引流通畅,并保持囊腔内清洁。术后定期复查和随访。结果:开窗减压术联合囊肿塞能够有效治疗颌骨囊肿,大大降低颌骨囊肿治疗中的手术创伤,保存颌骨及牙齿,维持颌面部外形和生理功能,是一种简便、有效的颌骨囊肿治疗方法。     

超声骨刀在颌骨囊肿手术中的临床应用

目的:探讨超声骨刀在颌骨囊肿手术中的临床效果。方法 :选取58例颌骨囊肿患者,随机分为A和B两组。A组采用超声骨刀手术,B组采用传统骨器械手术。观察2组手术时间、术中出血量、术后疼痛、伤口愈合及重要解剖结构(上颌窦黏膜、鼻腔黏膜、下颌神经管等)损伤情况。结果:A组术中出血量、术后疼痛程度及重要解剖结构损伤均显著小于B组;A组与B组手术时间无显著差异;创口均一期愈合。结论:超声骨刀安全、高效,降低了手术并发症。     

超声骨刀在上颌窦侧壁开窗提升种植术中的临床应用

目的：评价超声骨刀在上颌窦侧壁开窗提升牙种植术中应用的临床效果。方法：15例上颌后牙缺失患者,术前CBCT检查牙槽嵴顶距上颌窦底的骨量高度为3．0～6．5 mm,采用超声骨刀行上颌窦侧壁开窗提升术并同期植入19颗种植体,术后即刻CBCT观察上颌窦底黏膜、窦内情况及种植体植入情况,术后3天随访观察有无上颌窦黏膜破裂并发症状。结果：15例中无1例出现上颌窦黏膜破裂,术后CBCT检查所有患者上颌窦窦底黏膜提升成功,无上颌窦底黏膜破损者,无患者出现上颌窦内液体渗出堆积。术后3天内随访,均无鼻腔出现血性分泌物或骨粉等异物排出现象。结论：采用超声骨刀行上颌窦侧壁开窗提升牙种植术,可以大大减少种植手术的时间,降低了手术并发症的风险。     

压电超声骨刀在颌骨囊肿摘除术中的临床应用

目的：总结压电超声骨刀在颌骨囊肿摘除术中的临床应用特点,并评价其临床效果。方法：对4l例颌骨囊肿病例,应用压电超声骨刀进行骨开窗,其中8例配合使用电钻,摘除囊肿,6例囊腔用钛板将游离的自体骨块复位固定,关闭骨腔。观察超声骨刀的临床使用特点及临床效果。结果：4l例均完整摘除颌骨囊肿,其中1例因术中操作不当致鼻底黏膜损伤,其余病例无软组织损伤。伤口一期愈合。8例配合使用电钻者,骨切割效率明显提高。结论：颌骨囊肿摘除术中应用压电超声骨刀,手术精确度高,安全,方便。     

上颌窦黏膜囊肿对牙槽嵴顶入路上颌窦底提升术的影响

目的研究牙槽嵴顶入路上颌窦底提升术后,上颌窦内黏膜囊肿的变化和囊肿区种植体周围的成骨情况,探讨上颌窦黏膜囊肿对牙槽嵴顶入路上颌窦底提升术的影响。 方法选取12例上颌后牙缺失骨量不足并患有上颌窦黏膜囊肿的患者,在不摘除窦腔内黏膜囊肿的情况下,经牙槽嵴顶入路提升上颌窦底同期植入种植体14枚。术前测量上颌窦底高度,术后当日测量种植体穿入窦底长度,术后1年测量穿入窦腔内的种植体周围成骨高度,观察黏膜囊肿对种植体周围成骨的影响。采用配对样本t检验对比术前-术后当日及术前-术后6个月黏膜囊肿投影面积变化,评估手术创伤与黏膜囊肿的相互的影响。 结果通过牙槽嵴顶入路上颌窦底提升术植入的种植体在含有上颌窦黏膜囊肿的上颌后牙区种植体周围成骨良好,术后6个月时全部14枚种植体形成良好骨结合。术前上颌窦底高度为（5.5 ± 1.4）mm,术中种植体穿入上颌窦长度为（2.9 ± 1.3）mm,上颌窦底厚度平均增加了（1.8 ± 1.0）mm。根据测量结果计算黏膜囊肿投影面积,术前（201.2 ± 184.0）mm²,术后当日（133.6 ± 187.6）mm²,术后6个月（134.5 ± 107.1）mm²。术前-术后6个月的成对差分均值及标准差[（66.6 ± 142.8）mm²]明显增大,说明术后6个月时黏膜囊肿的体积呈现出多样化的表现。术前-术后当日的黏膜囊肿投影面积相比显著减小,差异有统计学意义（t= 2.685,P= 0.021）,术前-术后6个月的黏膜囊肿投影面积差异无统计学意义（t= 1.617,P= 0.134）。手术短期内会对上颌窦内黏膜囊肿造成一定的创伤,但未对上颌窦黏膜囊肿产生激惹、恶化等不良影响。 结论上颌窦内黏膜囊肿的存在不影响牙槽嵴顶入路上颌窦底提升术的实施与种植体周围成骨。     

超声骨刀在上颌窦内提升术中的应用

目的:探讨超声骨刀在上颌窦底内提升种植术中应用的效果和技术特点。方法:30名患者共36颗上颌磨牙缺失,牙槽嵴顶至上颌窦底之间的剩余骨高度2～8 mm,以超声骨刀行上颌窦底内提升术,同期或延期植入种植体。结果:24名患者植骨同时植入28枚种植体。6例因剩余牙槽骨高度少于5 mm先行上颌窦提升植骨术,6个月后延期植入8枚种植体。平均上颌窦底提升高度为426 mm(213～540 mm)。36个上颌窦提升位点,仅1例出现上颌窦黏膜穿孔,以Bio-Gide胶原膜修补。术后随访未发现种植体周围阴影或快速骨吸收。所有病例随访3～17个月,未见种植体脱落或松动现象。结论:超声骨刀上颌窦内提升术简单易学,避免了开窗式上颌窦提升术的术后反应,降低了上颌窦黏膜穿孔的机率,值得在临床上推广应用。     

牙源性上颌窦炎17例回顾性分析

目的探讨上颌窦炎的病因、发病机制以及诊疗方法。方法回顾性分析17例牙源性上颌窦炎的临床资料及诊疗经过。结果慢性牙源性上颌窦炎15例,急性牙源性上颌窦炎2例。根尖周炎继发感染8例,根尖囊肿或颌骨囊肿继发感染5例,拔牙损伤继发感染2例,根管治疗突入上颌窦继发感染2例。行上颌窦根治术13例,上颌窦瘘修补术4例,17例手术效果良好,治愈出院。结论鉴于上颌窦底壁结构复杂,牙源性上颌窦炎的治疗具有一定的特殊性,鼻内镜在牙源性上颌窦炎手术治疗中的应用具有重要的临床意义。     

超声内提升骨刀在上颌窦内提升术中的临床应用

目的:评价超声内提升骨刀在上颌窦内提升术中的技术优势。方法:16例上颌后牙缺失患者,上颌窦底剩余牙槽骨骨量为4～7 mm,采用超声内提升骨刀行上颌窦底黏膜内提升术,同期植入种植体30枚,术后6个月上部结构修复。随访18个月。结果:术中无1例上颌窦黏膜破裂,术中、术后患者均无头晕、头痛等不适,术后鼻腔无出血,也无骨粉等异物排出;术后种植体稳固,种植体周围牙龈组织健康,无一脱落,咀嚼功能恢复满意。数字曲面断层片显示种植体周围骨未见低密度影,无上颌窦炎症影像;术后18个月种植体末端骨高度(2.1±1.5)mm,窦底提升(3.6±1.8)mm,种植体边缘骨吸收(1.27±0.56)mm。结论:采用超声内提升骨刀代替骨凿技术行上颌窦底黏膜内提升术,具有高效、快速、患者不适感轻、不损伤窦底黏膜的优点,值得在临床上推广。     

Mucus retention cyst of the maxillary sinus: the endoscopic approach

OBJECTIVE: To present our experience of endoscopic surgery for symptomatic mucus retention cyst of the maxillary sinus. DESIGN: Retrospective study. SETTING: Teaching hospital, Israel. PATIENTS: 60 patients with 65 symptomatic cysts of the maxillary sinus who were operated on endoscopically. Only patients with large cysts that filled at least 50% of the sinus space were included. INTERVENTION: A rigid nasal endoscope was used in all cases; most of the cysts were removed through the natural sinus ostium. RESULTS: Cysts recurred in only two patients during the first postoperative year. There were no complications from the procedure. CONCLUSION: The endoscopic approach to the treatment of maxillary sinus cyst is associated with a low rate of recurrence (3% in this study) and no complications, and we recommend it as the surgical procedure of choice.     

Surgical management of odontogenic cysts involving the maxillary sinus- a retrospective study

ObjectiveTo describe our strategy for the management of odontogenic cysts involving the maxillary sinus, and to define the role of transnasal endoscopic sinus surgery in the treatment algorithm.MethodsA retrospective study was conducted. Included were all consecutive patients with odontogenic cysts involving the maxillary sinus who were treated in a single medical center between 2011 and 2019. Their medical records were reviewed for demographic data, preoperative presentation, surgical approach, final pathology, and postoperative course. Odontogenic cysts were classified as small or large according to maxillary sinus extension within or beyond the alveolar recess, respectively.ResultsA total of 30 patients with odontogenic cysts involving the maxillary sinus were treated by a team of maxillofacial and endoscopic sinus surgeons during the study period. There were 11 cases of dentigerous cysts, 11 radicular cysts, seven odontogenic keratocysts (OKCs), and one glandular cyst. Sixteen cases were managed by transnasal endoscopic sinus surgery alone and 14 were managed by a combined intraoral and endoscopic sinus surgery approach. A total of 22 patients had large cysts and total resection was achieved in 20 of them. There was one case of OKC recurrence during an average follow-up of 31 months. No major complications were recorded.ConclusionsThe endoscopic approach can serve as an alternative to the transalveolar or lateral window approach. The endoscopic approach is associated with low morbidity and low recurrence rates.     

Large radicular cyst in the maxillary sinus

Radicular cysts (RCs) are the most common inflammatory jaw cystic lesions that occur infected and necrotic in teeth pulps. They account for more than 50% of all odontogenic cysts. Radicular cysts cause slowly progressive painless swelling. There are no symptoms until they become large. Enucleating the cyst is recommended with primary treatment. Here we describe a patient with a large RC with maxillary sinus involvement who underwent an endonasal endoscopic approach for complete resection. In conclusion, the endonasal endoscopic approach should be kept in mind for the resection of RC with maxillary sinus involvement because of its minimally invasive characteristics.     

鼻内镜下两种手术径路治疗上颌窦囊肿80例临床分析

目的:探讨鼻内镜下两种手术径路治疗上颌窦囊肿的临床疗效。方法:通过比较35例采用上颌窦自然口径路与45例采用下鼻道开窗径路治疗上颌窦囊肿进行回顾性分析。结果:经鼻内镜下两种不同手术径路治疗,手术均获得成功,术中出血均少于50 mL,无明显手术并发症。继续随防6个月～1年,患者鼻腔通气良好,面部胀痛、头痛、头昏等临床症状消失,鼻内镜下检查见上颌窦腔光滑,无脓性分泌物,无复发。结论:鼻内镜下行上颌窦囊肿切除手术直观,创伤小,术后反应轻,根据上颌窦囊肿位置类型选择不同手术径路,效果更理想。     

Clinicopathologic study of the postoperative maxillary cyst

Sixty cases of the postoperative maxillary cyst were studied clinicopathologically. The cysts accounted for 19.5% of all oral cystic lesions. Most of the patients were in their 20s and 30s at the time of diagnosis, and the postoperative duration was between 10 and 49 years. Radiographically, most cases revealed a unilocular cystic lesion. In two thirds of the cases, the lesion occupied more than half the volume of the maxillary sinus while the remaining one third of the cases revealed more limited lesions of the sinus. Histopathologically, cuboidal, squamous, and mixed epithelial cyst linings were observed, although the basic epithelial lining was the ciliated columnar type. Epithelial dysplasia was found in two cases. The cysts near the nasal cavity may originate from regenerated nasal mucosa, and the cysts that are located at a distance from the nasal cavity may be lined with epithelium derived from residual mucosa of the sinus entrapped during surgery to relieve sinusitis.     

开窗减压联合生物材料填充治疗颌骨大型囊性病变的研究

目的:评价开窗减压术联合生物材料硫酸钙填充治疗颌骨大型囊性病变的临床疗效。方法:选取颌骨大型囊性病变患者70例,随机均分为观察组和对照组,观察组行I期开窗减压保守治疗,待囊肿明显缩小后行Ⅱ期小囊肿刮除术并硫酸钙生物材料充填术;对照组行传统颌骨囊肿刮除术,同时予以硫酸钙生物材料充填术。观察并比较两组患者手术时间、术中出血量、术后疼痛及感染、囊腔体积缩小程度、骨质增生厚度及骨密度值、术后复发率及神经性并发症发生情况。结果:两组患者手术时间、术中出血量、术后疼痛及感染发生率相比差异具有统计学意义(P＜0.05);术后6月各指标较术后3月均明显改善,观察组术后3、6月囊腔缩小值、术后骨质增生厚度、术后骨质密度值均优于对照组,差异具有统计学意义(P＜0.05);术后均随访12~24月,对照组1例复发,观察组无复发,差异无统计学意义。结论:采用开窗减压术治疗颌骨大型囊性病变手术创伤小,可保护囊肿周围血管神经等重要结构;在囊肿刮出后采用医用硫酸钙充填缺损骨腔,防止软组织嵌入,加快了成骨速度,降低术后复发。     

颌骨囊肿开窗术的临床效果评价

目的:探讨和评估囊肿开窗术在颌骨囊肿临床治疗中的应用。方法:对60例颌骨囊肿患者实行开窗术,吸出囊内容物,不刮除其余囊壁,使囊腔与口腔相通呈开窗状态,碘仿纱条填塞,术后换药,并定期复查和随访。结果:所有病例均未出现长期反复感染,患者颌骨形态良好,未出现神经及邻近重要结构损伤症状。术后6月～3年随访,X线片示骨质再生情况良好,未见有囊肿复发。结论:颌骨囊肿开窗术是一种简便、经济、安全、效果良好的治疗颌骨囊肿的方法。     

Recurrent calcifying odontogenic cyst involving the maxillary sinus

The calcifying odontogenic cyst is an uncommon lesion that occurs in both jaws, however involvement of the maxillary sinus is rare. The accepted mode of treatment is enucleation with curettage since it is generally believed that recurrence following such treatment is extremely rare. Of the reported cases of recurrent calcifying odontogenic cysts, none have involved the maxillary sinus. This report is of a large recurrent calcifying odontogenic cyst involving the maxillary sinus, eroding the orbital floor as well as anterior and medial walls of the maxillary sinus and displacing an impacted upper canine into the nasal cavity, in a 45-year-old male patient, 8 years after the initial enucleation.     

伴上颌窦囊肿或慢性上颌窦炎的上颌窦底外提升术效果评价

目的探讨伴上颌窦囊肿或慢性上颌窦炎的经外侧壁开窗上颌窦底提升术同期牙种植的治疗效果。 方法从2014年3月至2018年3月期间在广州市海珠区口腔医院种植修复科以及口腔外科诊治的行经外侧壁开窗的上颌窦底提升术同期牙种植的患者共53例种植体，根据文献报道的纳入标准，分为三组，可进行上颌窦底提升术的伴上颌窦囊肿者为囊肿组共17例，可进行上颌窦底提升术的伴有慢性上颌窦炎者为炎症组共15例，上颌窦内无明显炎症或囊肿者为正常对照组共21例。术前记录上颌窦黏膜厚度，上颌窦底剩余牙槽骨高度（RBH），术中记录有无上颌窦黏膜撕裂、破裂。术后7 d记录术后并发症情况，定期随访，在修复后12个月记录分析上颌窦内成骨高度（SBG）、种植体尖端成骨高度（ABH）、种植体边缘骨吸收（MBL）、上颌窦囊肿变化或上颌窦黏膜增厚情况。使用SPSS 20.0进行数据统计分析。术后急性感染比较使用卡方检验中Fisher精确检验，三组间的上颌窦黏膜厚度、上颌窦内成骨、边缘骨吸收等指标使用单因素方差分析进行差异比较，术前、术后囊肿直径和上颌窦黏膜厚度对比使用配对t检验。 结果三组病例术中均未出现上颌窦黏膜撕裂。囊肿组2例、炎症组3例、对照组1例出现术后急性上颌窦炎，三组间急性炎症例数差异无统计学意义（χ² = 2.049，P = 0.352）。三组病例均无术后上颌窦积血、积液等情况。修复后12个月，囊肿组SBG为（8.09 ± 1.20）mm，炎症组SBG为（7.17 ± 1.18）mm，对照组SBG为（7.36 ± 1.41）mm，组间比较差异无统计学意义（F = 2.409，P = 0.100）；囊肿组ABH为（1.94 ± 1.34）mm，炎症组ABH为（1.40 ± 1.12）mm，对照组ABH为（2.10 ± 1.30）mm，组间差异无统计学意义（F = 1.382，P = 0.261）；囊肿组MBL为（0.53 ± 0.70）mm，炎症组MBL为（0.47 ± 0.92）mm，对照组MBL为（0.48 ± 0.67）mm，组间差异无统计学意义（F = 0.118，P = 0.889）。囊肿组术后囊肿直径[（2.35 ± 3.51）mm]较术前的囊肿直径[（8.41 ± 3.04）mm]有所缩小，差异有统计学意义（t = 5.216，P<0.001）。炎症组术后黏膜厚度[（6.27 ± 2.15）mm]较术前厚度[（5.27 ± 1.58）mm]有所增加，差异有统计学意义（t = -2.562，P = 0.023）。 结论伴上颌窦囊肿或慢性上颌窦炎的经外侧壁开窗的上颌窦底提升术同期牙种植可以取得较好的临床效果。