CBCT在闭合式上颌窦内提升术的临床应用研究

目的：探讨锥束CT（Cone Beam Computer Tomography,CBCT）评估上颌后牙区牙槽骨高度准确程度,评价其指导闭合式上颌窦内提升术的临床效果。方法：对55例计划行上颌后牙区种植患者拍摄CBCT,根据分析结果将适合行上颌窦内提升术患者纳入研究人群,治疗结束后评估其临床效果。结果：CBCT上颌后牙区牙槽骨骨量不足者检出45例,1例上颌窦根尖囊肿,2例窦底粘膜过度增生,其中4例窦底距离牙槽嵴顶骨高度小于4mm者建议使用上颌窦侧壁开窗上颌窦底提升植骨手术,38例完成闭合式上颌窦内提升并全部完成修复,成功率为100%。结论：CBCT在上颌后牙区颌骨骨量判断及术前指导有着重要作用。     

开窗引流冲洗术治疗青少年颌骨囊肿的临床观察

目的：探讨开窗引流冲洗术在青少年大型颌骨囊肿临床的疗效。方法：对48例青少年大型颌骨囊肿患者实行开窗引流冲洗术,观察颌骨骨质情况,术后1、3、6及12个月复查曲面断层片,观察牙及牙胚的情况,并定期复查和随访。结果：所有病例均未出现长期反复感染,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个月～3年随访,示骨质再生情况良好,囊肿未见复发。颌骨、牙、矛胚发育生长良好。结论：开窗引流冲洗术是一种简便、经济、安全、效果良好的治疗青少年大型颌骨囊肿的方法,且颌骨、牙、牙胚生长发育不受影响,值得在基层医院开展。     

锥型束CT在上颌Le Fort Ⅰ型截骨术中的应用

目的 探讨提高Le Fort Ⅰ型截骨术的安全性和准确性的方法.方法 对84例上颌正颌手术患者术前行锥型束CT(conebeam computed tomography,CBCT)扫描,提取不同的影像资料,测量定位上颌Le Fort Ⅰ型截骨区域重要解剖结构位置.结果 84例中,术前检查发现上颌窦严重发育不全3例,其各骨壁距离测量值远小于正常值;上颌第3磨牙高位阻生11例;上颌窦分隔8例,鼻中隔偏曲4例;上颌窦囊肿3例.该成像技术对正颌手术患者上颌骨翼腭管位置关系,上颌骨各骨壁的厚度,上颌窦分隔,上颌窦内潜伏病变,上颌高位阻生牙的定位,翼上颌联合情况,以及鼻中隔偏曲情况均有良好的显示,为上颌正颌手术方案设计提供了放射学的颌骨评估基础,可指导Le Fort Ⅰ型截骨的定位设计.结论 CBCT可为上颌Le Fort Ⅰ截骨提供更精准的结构解剖影像,从而提高手术的准确性与安全性.

Abstract：

Objective To improve the accuracy and safety of the Le Fort Ⅰ osteotomy. Methods Eighty-four patients underwent CBCT scan before maxillary orthognathic surgery. The anatomic structures of maxilla were marked and measured. Results In 84 cases, there were 3 cases with severe hypoplasia of maxillary sinus, 11 cases with impacted third molar, 8 cases with separation in maxillary sinus, 4 cases with the deviation of nasal septum, and 3 cases with cysts in maxillary sinus. Form CBCT images, the position of the pterygopalatine canal, the thickness of maxillary wall, hidden lesion of maxillary sinus, the location of Impacted molar, the deviation of nasal septum, and other anatomic structure could be accurately localized. CBCT could provide sufficient and valuable information in diagnosis and design for Le Fort Ⅰ osteotomy. Conclusions CBCT imaging technology could provide precise anatomic images for Le Fort Ⅰ osteotomy. It improves the accuracy and safety of the Le Fort Ⅰ osteotomy.     

鼻内镜下切除上颌窦淋巴管瘤1例

本文报道1例2014年9月我科术前诊断上颌窦浆液性囊肿,经鼻内镜下手术切除后确诊为淋巴管瘤。术后6个月鼻内镜下见上颌窦腔内黏膜光滑,未见囊肿样新生物复发。我们认为上颌窦淋巴管瘤与上颌窦浆液性囊肿,在CT及鼻内镜直视下均不易鉴别,可在鼻内镜下彻底切除,切除后不易复发。     

鼻内镜下切除侵及上颌窦上颌骨囊肿的临床观察

颌骨囊肿是口腔颌面外科常见的良性病变,根据组织来源和发病部位分为牙源性颌骨囊肿和非牙源性颌骨囊肿,以牙源性囊肿多见,又分为根尖周囊肿、始基囊肿、含牙囊肿、牙源性角化囊肿类型[1]。临床治疗以开窗引流术及囊肿摘除术为主,侵及上颌窦的较     

鼻内镜下经下鼻道钻孔上颌窦囊肿切除术

目的　探讨鼻内镜下简单有效的上颌窦囊肿手术切除方法。　方法　应用Rudolf 4 5mm套管穿刺针 ,经下鼻道钻孔 ,套管内追踪囊肿 ,上颌窦活检钳钳夹切除囊肿 36例。　结果　 30例随访 0 5年～ 3年 ,复查X线片或CT无复发。　结论　鼻内镜下经下鼻道钻孔上颌窦囊肿切除 ,是一种手术创伤小 ,疗效肯定的术式。     

鼻内镜下治疗上颌窦囊肿52例临床分析

目的探讨鼻内窥镜下上颌窦囊肿切除的方法。方法于鼻内窥镜下行中鼻道开窗,中、下鼻道联合开窗及中鼻道、尖牙窝联合开窗术治疗上颌窦囊肿52例。结果所有囊肿均在内窥镜下完整切除,随访1年无复发。结论应用鼻内窥镜切除上颌窦囊肿创伤小、操作简便、出血少、效果确切,是治疗上颌窦囊肿的有效首选方法。     

牙周炎患者牙龈组织中ET和NO改变与局部骨吸收的研究

目的　为了探讨慢性牙周炎患者牙龈组织中 Ｅ Ｔ 和 Ｎ Ｏ 的改变与局部颌骨的吸收及骨质疏松的关系。方法　本研究对２０例正常人及２０例慢性牙周炎患者应用组织化学、免疫组织化学、颌骨 Ｘ 线曲面断层片图象等方法对各牙龈组织中免疫活性物质内皮素（ Ｅ Ｔ）和一氧化氮（ Ｎ Ｏ）及相应颌骨 Ｘ 线曲面断层片的检测结果进行定量的图象分析。结果　显示慢性牙周炎患者牙龈组织中 Ｅ Ｔ 含量明显升高,颌骨密度减低,牙槽骨水平吸收显著。结论　研究结果提示,慢性牙周炎时牙龈组织中 Ｅ Ｔ 和 Ｎ Ｏ 的改变与局部颌骨的吸收及骨质疏松有密切的关系     

口腔颌面锥形束CT在髁突骨折诊断及治疗中的应用

目的：探讨口腔颌面锥形束CT（CBCT）在髁突骨折诊断及治疗中的应用。方法：回顾分析西安交通大学口腔医院口腔颌面外科自201O年1月～2012年6月诊治的髁突骨折42例（59侧）,每例患者术前均行CBCT检查。其中有28例（32侧）在CBCT检查之前已行曲面断层全景片检查,17例（25侧）已行螺旋cT检查。结果：2侧骨折经曲面断层颌全景片检查后漏诊,漏诊率6．25％;螺旋cT和CBCT检查无误诊和漏诊,均可以确诊髁突骨折,并明确骨折部位及分型。42例（59侧）髁突骨折中,髁头（囊内）骨折13侧,髁颈骨折27侧,髁突下骨折19侧。13侧囊内骨折中,A型7侧,B型4侧,C型0例,M型2侧。PDA分类,Ⅰ型28侧,Ⅱ型11侧,Ⅲ型20例。结论：对于髁突骨折的诊断,CBCT是一种简单可靠的影像学技术,并可以明确骨折类型,对其治疗具有重要的指导意义。     

上颌侧切牙先天缺失的影像学分析

目的：应用曲面断层技术探讨上颌侧切牙先天缺失的发生率和影像学特征,分析上颌侧切牙先天缺失的分布规律及影像学特点。方法：收集笔者医院2020年1月-2021年6月就诊的儿童口腔科患者的曲面断层片,共纳入25 556张,观察记录上颌侧切牙先天缺失的发生情况,应用SPSS24.0统计软件分析所得的数据。结果：上颌侧切牙先天缺失的发生率为0.78%(200/25 556),男性(114例)多于女性(86例),但性别间差异无统计学意义(P=0.230);上颌侧切牙缺失1颗者占74.50%,左上颌侧切牙缺失119颗,略少于右侧的132颗,差异无统计学意义(P=0.410)。单侧缺失149例,明显多于双侧缺失51例,差异有统计学意义(P=0.000)。结论：先天性上颌侧切牙缺失会引起各种美学和功能问题,上颌侧切牙先天缺失可能导致中切牙之间有缝隙,中切牙和尖牙之间出现间隙,尖牙近中移动,单侧缺失时中线偏移。应用曲面断层技术进行检查,可早期发现牙齿先天缺失,早期干预,设计合理的治疗方案。     

Correlation between maxillary sinus floor topography and related root position of posterior teeth using panoramic and cross-sectional computed tomography imaging.

OBJECTIVE: This study correlated the topographic relationship of the maxillary sinus floor to the roots of posterior teeth imaged by panoramic radiography and cross-sectional computed tomography (CT). STUDY DESIGN: Paired panoramic radiographs and CT images of maxillae from 80 subjects were analyzed. A total of 422 maxillary roots were classified according to their topographic relationship to the maxillary sinus and measured according to their projection lengths on the sinus cavity for both imaging modalities. Correlations between the 2 radiographic techniques were examined statistically. RESULTS: Teeth roots that did not contact the sinus floor or contacted it but did not project on the sinus cavity (classifications 0 and 1) showed a high agreement of 86% to 96% when using the 2 imaging techniques. Only 39% of the teeth roots that projected on the sinus cavity in panoramic radiographs (classification 3) showed protrusion into the sinus with CT. The panoramic radiographs showed a statistically significant 2.1 times longer root projection on the sinus cavity in comparison to the root protrusion length into the sinus measured by using CT images (P < .001). CONCLUSION: For the majority of the roots projecting on the sinus cavity in panoramic radiographs, no vertical protrusion into the sinus was observed in CT images. Roots that did protrude into the sinus in the CT showed a protrusion length that was much shorter than the projection length appearance using panoramic radiography.     

Gross extrusion of endodontic obturation materials into the maxillary sinus: a case report.

A gross extrusion of endodontic obturation materials occurred from tooth 3 into the right maxillary sinus. The patient had never been conscious of uncomfortable symptoms, both at tooth 3 or buccal regions. A computed tomographic (CT) scan showed cord-like foreign substances extruded from the apex of the tooth and the hyperplasticity of the sinal mucosa. The surgical removal of foreign substances and partial curettage of sinal mucosa were indicated to prevent the possibility of sinus infection. At the 4-month recall, the patient was symptom free. This case emphasizes that an open apex can become potentially dangerous when the vertical condensation method is used. If massive overfilling is recognized radiographically in molar regions, an examination using panoramic radiograph is indispensable to detect the gross extrusion into the maxillary sinus, such as in this case.     

Case report: B-cell lymphoma of the maxillary sinus.

The radiographic manifestation of malignant lesions of the maxillary sinus on dental radiographs may be nonspecific, making it difficult to differentiate the lesion from disease of odontogenic origin or more benign sinus pathoses. A radiopaque mass in the maxillary sinus, resulting from a malignant neoplasm growing within or extending into the sinus, can be easily confused with the mass of a mucous retention pseudocyst. Similarly, a malignant growth in the early stages of development can produce radiographic patterns in the alveolar process that may resemble inflammation of odontogenic origin. A case of B-cell lymphoma is reported. The lesion involved the maxillary alveolar process and sinus, producing such a radiographic pattern on the panoramic radiograph. Radiographic and clinical features that should be considered in establishing a differential diagnosis of malignant disease are discussed.     

Endoscopic removal of a maxillary dentigerous cyst

Developmental odontogenic cysts account for 10% of all cysts of the jaw. Dentigerous cysts are benign odontogenic cysts. They are associated with the crowns of unerupted teeth. A 24-year-old woman presented with headache, facial pain and facial swelling during the previous six months. Computed tomography revealed a dentigerous cyst in the right maxillary sinus floor. The cyst was removed and the tooth was extracted transnasally with the help of an endoscope. Our case was exceptional because it was seen in a rare area outside the dental area: it was located in the floor of the right maxillary sinus, and it was removed transnasally rather than with one of the more common approaches such as a Caldwell-Luc procedure. This article discusses the dentigerous cyst case, as well as the relevant literature.     

Mucosal regeneration of the maxillary sinus after surgery

The postsurgical effects of the removal of the maxillary sinus mucosa were studied in an animal model. Ten rabbits underwent Caldwell-Luc procedures with the removal of all the maxillary sinus mucosa from one sinus, while the other sinus in each animal was used as a control. After allowing time for postsurgical healing, animals were examined for mucociliary transport and sections for histologic examination were obtained. Respiratory ciliated epithelium was present in seven of the postsurgical sinuses. Marked increases in acute and chronic inflammation, granulation, fibrosis, and ulcerations were noted.     

锥形束CT在上颌埋伏中切牙正畸治疗中的应用

目的:评价锥形束CT(CBCT)在上颌埋伏中切牙正畸治疗中的应用价值。方法:选择在我院就诊的上颌埋伏中切牙患者54例(男32例,女22例),应用CBCT进行扫描和图像三维重建,显示埋伏中切牙的形态、位置、牙根弯曲情况以及与邻牙的关系。结果:经CBCT三维重建后,54例病例均清晰的显示了埋伏中切牙的牙体形态、唇腭向位置、萌出方向、牙根弯曲情况以及与邻牙的关系。结论:CBCT检查能提供准确,直观的信息,对上颌埋伏阻生的诊断,治疗设计具有更好的指导意义。     

Cyst decreased in size post maxillary sinus floor augmentation surgery in diabetic patient: A case report

IntroductionWhether mucosal cyst of maxillary sinus is contraindication for sinus floor augmentation surgery has been a controversial hot spot for years.Presentation of caseThis case aims to present the surgical procedure of sinus floor augmentation surgery with cyst (18.72 mm × 24.61 mm) in diabetic patient. And 6 months later, the cyst decreased in size. The authors elevated the sinus floor and cyst simultaneously. The surgery was carried out successfully without sinus membrane perforation and the alveolar ridge gained about 8 mm height. Six months later, the cyst decreased in size and osseointegration was observed.DiscussionInterdisciplinary cooperation is encouraged to diagnose benign mucosal cyst. The isolation between sinus lumen and the grafted sub-sinus space is important. Graft contamination or dispersion into the sinus lumen should be avoided. The integrity of the sinus membrane and use of antibiotics are very important to prevent the occurrence of postoperative sinus infectionConclusionThe authors conclude that sinus augmentation surgery could be done with mucosal cyst in diabetic patient.     

上颌窦囊肿的微创手术治疗

目的总结鼻内镜治疗上颌窦囊肿的手术疗效。方法回顾性分析鼻内镜手术治疗35例(41侧)上颌窦囊肿的临床资料,其中经下鼻道开窗25侧,经上颌窦自然开口12侧,中、下鼻道同时开窗4侧。结果术后3个月内临床症状均消失,平均随访12个月,均无复发,内镜定期复查示上颌窦开口通畅,下鼻道粘膜光滑,上颌窦腔内粘膜恢复良好。结论内镜手术是治疗上颌窦囊肿安全、有效的方法。