陈旧性口腔上颌窦瘘的临床与治疗—附63例报告

本文报道了63例陈旧性口腔上颌窦瘘手术治疗情况及随防结果。对口腔上颌窦瘘的预防及处理,手术方法的选择及其成功的关键等进行了讨论。     

颊脂垫修补口腔-上颌窦瘘21例

<正> 口腔-上颌窦瘘多系外伤、上颌窦炎症、拔牙及上颌窦手术不慎造成穿孔的后遗症,以拔牙时牙根或器械误入而引起的最常见。穿孔后由于口腔、上颌窦、鼻腔相互交通,造成患者饮食与发音的功能障碍。由于穿孔的范围、部位、术者的技术等诸多原因,传统修补法时有失败。作者采用颊脂垫修补口腔-上颌窦瘘取得了良好效果,现介绍如下。     

口腔上颌窦瘘手术修复

口腔上颌窦瘘的形成原因可能是上颌磨牙拔除术、颌面创伤、上颌窦炎、上颌囊肿或肿瘤手术。穿孔后口腔、上颌窦、鼻腔相互交通,造成患者饮食、发音等功能障碍。虽然可利用活动义齿暂时封闭瘘孔,但决定性的治疗依赖于手术。口腔上颌窦瘘手术修复的方法有多种,如颊侧黏骨膜瓣、腭黏骨膜瓣修复等。本文报道作者所在单位近10年来收治的17例患者的治疗经验。     

上颌第一磨牙缺失合并口腔上颌窦瘘种植修复一例

口腔上颌窦瘘是指口腔与上颌窦发生的病理性连通。由于上颌窦底骨板的缺损,在缺牙区进行种植治疗具有较大困难。本文报道1例上颌第一磨牙缺失合并口腔上颌窦瘘的病例,上颌窦底缺损直径大于5 mm。一期手术行口腔上颌窦瘘修补术及位点保存术;二期手术行经侧壁开窗上颌窦底提升术及引导骨再生术,同期植入种植体,完成上部结构修复。通过治疗...     

用基托封闭治疗口腔上颌窦瘘

用基托封闭治疗口腔上颌窦瘘中山医科大学孙逸仙纪念医院（５１０１２０）钟志海由于上颌磨牙与上颌窦的解剖关系，因拔牙取上颌断根、进行上颌骨或上颌窦手术时，方法不当会导致发生口腔上颌窦瘘。对这类患者，按传统的方法一般是采用手术治疗，而关闭口腔上颌窦瘘的手术...     

颊瓣即刻修补上颌窦意外穿孔21例随访观察

在临床上因断根误入上颌窦引起的上颌窦意外穿孔时有发生.有些病员因处理不当,可长期遗留口腔上颌窦瘘或慢性上颌窦炎.作者对我院1981年至1994年以来的21例因断根引起的上颌窦意外穿孔的病员,术后均采用颊瓣行即刻修补术的随访观察,显示了颊瓣良好的修复效果,现报告如下.     

误入上颌窦内牙根取出及穿孔修复的体会

本文将经上颌窦前壁穿刺上颌窦内生理盐水冲洗法取根,并采用脱细胞真皮基质(aceliular demalmatrix,ADM)修补上颌窦穿孔及口腔上颌窦瘘的体会总结如下。1.临床资料:2005年4月～2007年4月共收治17例患者,男9例,女8例,年龄20～43岁。牙根误入上颌窦内患者13例,单纯术后穿孔并形成     

脱细胞真皮基质复合小牛脱细胞骨修复口腔上颌窦瘘

目的 评价脱细胞真皮基质复合小牛脱细胞骨修复口腔上颌窦瘘的效果。方法 选择上颌骨囊肿摘除术或上颌磨牙拔除术后口腔与上颌窦相通的9例口腔上颌窦瘘患者（缺损大于5 mm×5 mm）,采用脱细胞真皮基质复合小牛脱细胞骨进行同期植入修复缺损。结果 9例患者术后切口均一期愈合,随访6个月,口腔上颌窦相通处黏膜均未见瘘道及分泌物,无鼻塞、流脓涕等上颌窦炎症相关症状,临床检查鼓气试验及CT检查均证实创口愈合。结论 应用脱细胞真皮基质及小牛脱细胞骨修复口腔上颌窦瘘,是一种有效的治疗方法。     

腭黏骨膜旋转瓣修复口腔上颌窦瘘1例

上颌磨牙及前磨牙与上颌窦关系密切,拔除后创口有可能与上颌窦相通,甚至形成口腔上颌窦瘘。本文报道1例应用腭黏骨膜旋转瓣成功修复口腔上颌窦瘘的病例,通过良好的炎症控制、精确的组织瓣设计,获得良好治疗效果。     

口腔上颌窦(或鼻腔)瘘的治疗方法

口腔上颌窦(或鼻腔)瘘是一种常见的疾病,其发生原因是各种各样的,大致可归纳如下: 走马牙疳后遗症;腐烂很快的溃疡如梅毒树胶肿、麻疯或利什曼病;损伤;良、恶性肿瘤手术后;医源性如囊肿手术时用力过大或因原来骨板比较薄或拔牙时用力过大;腭裂修复后穿孔……等。口腔上颌窦(或鼻腔)瘘对病员带来极其     

基于袋状可吸收生物膜行上颌窦瘘软、硬组织同期修补术的临床应用及操作规范

上颌窦瘘是由于多种因素造成的异常口腔-上颌窦交通,是口腔颌面外科较为常见的一种疾病。传统上对于上颌窦的修补为基于各种软组织瓣的转移修复,在修补上颌窦瘘的同时,缺少骨组织的同期修复。基于袋状可吸收生物膜技术,单纯利用生物医用材料,在不用自体骨的情况下可完成上颌窦瘘区域软、硬组织的同期修复与再生。该治疗技术具有创伤小、手术难度适中,临床效果可靠,易于推广等特点,越来越受到医师和患者的青睐。但由于口腔医师临床技术水平参差不齐,为规范该技术临床操作标准、保障治疗效果、降低术后并发症,在此提出上颌窦瘘软、硬组织同期修补术的临床应用及操作规范,旨在为广大口腔医师在应用该项技术时提供参考。     

拔牙导致上颌窦瘘22例报告

目的 :探讨拔牙导致上颌窦瘘的原因、治疗方法及预防措施。方法 :收集 1994-2 0 0 2年间我科门诊拔牙导致上颌窦瘘病例 2 2例 ,进行回顾性分析。结果 :2 2例中 ,拔除上颌埋伏尖牙 4例 ,拔除上颌第一磨牙 8例 ,拔除上颌第二磨牙 4例 ,拔除上颌第三磨牙 5例 ,拔除上颌第二前磨牙 1例。术后即时发现者 2 0例 ,立即进行了保守治疗 ,其中 17例处理后瘘口 1周左右愈合 ,3例换药后行瓦合瓣修复。另外 2例于术后发现 ,1例换药后瘘口愈合 ,1例行瓦合瓣修复。保守治疗有效率 90 %。结论 :拔除上颌后牙及埋伏尖牙 ,均可能出现上颌窦瘘 ,正确及时的保守治疗多数可以一期愈合。     

Non-surgical management of stage 3 biphosphonate-related oroantral fistula

We describe the case of a patient with an oroantral fistula that healed successfully after conservative treatment.     

Palatal rotation-advancement flap for delayed repair of oroantral fistula: a retrospective evaluation of 63 cases

OBJECTIVE: To review our 17-year clinical experience with delayed oroantral fistula repair by palatal rotation-advancement flap, and to report its advantages, disadvantages, and complications. STUDY DESIGN: The records of 63 patients with late oroantral fistula treated by palatal rotation-advancement flap from 1984 to 2002 were reviewed. Eleven had undergone unsuccessful closure with a buccal flap. Data recorded were patient age and sex, cause of fistula, signs and symptoms, interval from appearance of fistula to repair, fistula size, radiographic appearance, method of repair, and immediate and late complications. RESULTS: There were 35 women and 28 men aged 21 to 71 years (mean 50.3 years). Surgery was performed 3 months to 20 years after injury (mean 1.8 years). Twenty-four patients had acute maxillary sinusitis and 39 had chronic sinusitis. The main causes of oroantral fistula were extraction of the second and first molars and pathological lesions within the sinus. Average fistula size was 2.3 cm x 1.6 cm. Fifty-one repairs were preceded by Caldwell-Luc operation. All fistulas were successfully closed with the palatal rotation-advancement flap, with minimal complications on long-term follow-up. CONCLUSION: The palatal rotation-advancement flap is recommended for the late repair of oroantral fistula owing to its good vascularization, excellent thickness and tissue bulk, and easy accessibility; it also allows for the maintenance of the vestibular-sulcus depth. It is particularly indicated in cases of unsuccessful buccal flap closure.     

A preliminary study of monocortical bone grafts for oroantral fistula closure

Sinus floor elevation has become a standard procedure in patients affected by severe maxillary atrophy, before implant placement, provided that the maxillary sinus is intact and uninfected. In the case of an oroantral fistula, simple soft tissue closure may interfere with the process of elevating the Schneiderian membrane. Total regeneration of the bony sinus floor is necessary to prevent disruption of the sinus membrane. In this study, 5 patients with oroantral fistulae of different causes were treated with autogenous monocortical bone blocks harvested from the chin. Press-fit closure for bony repair of the basal maxilla was sufficient in 3 of them. Two patients needed additional internal graft fixation. In the meantime, the 3 aforementioned patients underwent a successful sinus lift procedure. The use of a monocortical bone block for the closure of an oroantral fistula is recommended before internal sinus augmentation.     

Risk factors associated with oroantral perforation during surgical removal of maxillary third molar teeth

Purpose

The relationship between radiographic findings and the occurrence of oroantral perforation is controversial. Few studies have quantitatively analyzed the risk factors contributing to oroantral perforation, and no study has reported multivariate analysis of the relationship(s) between these various factors. This retrospective study aims to fill this void.

Methods

Various risk factors for oroantral perforation during maxillary third molar extraction were investigated by univariate and multivariate analysis. The proximity of the roots to the maxillary sinus floor (root-sinus [RS] classification) was assessed using panoramic radiography and classified as types 1–5. The relationship between the maxillary second and third molars was classified according to a modified version of the Archer classification. The relative depth of the maxillary third molar in the bone was classified as class A–C, and its angulation relative to the long axis of the second molar was also recorded.

Results

Performance of an incision (OR 5.16), mesioangular tooth angulation (OR 6.05), and type 3 RS classification (i.e., significant superimposition of the roots of all posterior maxillary teeth with the sinus floor; OR 10.18) were all identified as risk factors with significant association to an outcome of oroantral perforation.

Conclusion

To our knowledge, this is the first multivariate analysis of the risk factors for oroantral perforation during surgical extraction of the maxillary third molar. This RS classification may offer a new predictive parameter for estimating the risk of oroantral perforation.

     

Immediate repair of the oroantral communication: a preventive dental procedure

A two-layer sliding flap technique to repair an oroantral communication has been described. This procedure can be performed quickly and without special instrumentation. No additional regional anesthesia is necessary. It does not require reduction of the buccal plate and therefore preserves the integrity of the alveolus. Most importantly, this technique can reduce the incidence of oroantral fistula and subsequent secondary reparative operations.     

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??Oroantral perforation is one of the most common complications of extraction of teeth. If the perforation is not detected or treated improperly??it will lead to serious consequences??such as maxillary sinus fistula and maxillary sinusitis. At present??the treatment for oroantral perforation is mainly divided into surgical treatment and non-surgical treatment. With the deepening of the concept of minimal invasion and the development of biomaterials??the use of biological materials for filling and other non-surgical methods in the treatment of oroantral perforation have been more and more widely promoted. At present??the filling materials used in the treatment of oroantral perforation include??nonabsorbable material??absorbable material and blood material. This review will introduce the clinical data of filling materials for oroantral perforation??to provide reference for the treatment of oroantral perforation.     

Closure of oroantral fistula

Oroantral fistula is an uncommon complication in oral surgery. Although smaller fistulas of less than 5 mm in diameter may close spontaneously, larger fistulas always require surgical closures. The literature review revealed various procedures for the closure of oroantral fistulas. These procedures may be subdivided into local flap, distant flap and grafting. Procedures involving local flaps are usually adequate to close minor to moderate size defects. Those procedures utilizing the buccal mucoperiosteal flap as the tissue closure include straight-advancement, rotated, sliding and transversal flap procedures; while those involving the palatal mucoperiosteum are straight advancement, rotational-advancement, hinged and island flap procedures. The combinations of various local flaps to strengthen the tissue closure are also being advocated. The advantages and the limitations of these procedures are discussed. Distant flaps and bone grafts are usually indicated in the closure of larger defects in view of their greater tissue bulks. Tongue flaps have superseded extra-oral flaps from extremities and forehead for aesthetic reasons and also in view of their similar tissue replacement. Various tongue flap procedures are described. At present, various alloplastic materials such as gold, tantalum and polymethylmethacrylate are infrequently reported in the closure of oroantral fistulas. However, in the light of successful reports over the use of biological materials, collagen and fibrin, in the closure of oroantral fistulas, there seems to be another simple alternative technique for treating oroantral fistulas.     

106例拔牙导致口腔上颌窦交通的临床分析

目的 分析拔牙导致口腔上颌窦交通(oroantral communications,OAC)的临床特点、处理方法、预后情况及预防措施.方法 收集106例自2017年1月至2020年6月间在第四军医大学口腔医院口腔外科处理OAC患者的病历资料,并进行回顾性分析.结果 OAC好发于10～30岁,男女发生比例1:1.25.最...