开窗减压术治疗上颌骨大型囊性病变的临床研究

目的：探讨开窗减压术在上颌骨大型囊性病变治疗中的临床应用效果。方法回顾2007年10月—2014年10月治疗的25例上颌骨大型囊性病变开窗减压术治疗病例,观察上颌窦形态、囊腔大小及周围骨质变化。结果25例患者中,8例患者开窗减压术后3个月上颌窦骨壁厚度增加,上颌窦形态完全恢复,囊肿消失,未行囊肿刮治术;17例患者术后9～12个月上颌窦形态完全恢复或基本恢复,二期行囊肿刮治术。术后随访1～5年,无复发。结论上颌骨大型囊性病变开窗减压术具有能恢复上颌窦的形态和功能、创伤小、并发症少等优点。     

突入上颌窦的囊性病变85例CT分析

目的 :探讨牙源性上颌窦囊性病变部位及其鉴别诊断,以提高术前诊断的准确率,指导手术方案。方法 :回顾2011年12月—2014年12月就诊于上海交通大学医学院附属第九人民医院口腔外科经螺旋CT诊断为牙源性囊性病变侵及上颌窦的患者,统计上颌窦前外、后、内、下、上5个壁被侵犯的比例。筛选其中有病理诊断者,分析其影像学表现,并结合临床表现进行病种总结和鉴别诊断。结果:85例突入上颌窦的牙源性囊性病变中,侵及上颌窦下壁和后壁者最多。含牙囊肿、根尖囊肿、牙源性角化囊性瘤多见,有2例影像学诊断为成釉细胞瘤,但病理检查为黏液表皮样癌和腺样囊性癌。结论:牙源性囊性病变多侵及上颌窦后壁和下壁,需依赖影像、临床表现和病理检查三者结合,以做出准确诊断。     

3种径路鼻内镜下治疗上颌窦囊肿150例疗效分析

目的：探讨3种径路鼻内镜下治疗上颌窦囊肿的疗效差异。方法：分析近年来收治的150例上颌窦囊肿病例的临床资料,依据囊肿不同位置及是否伴有其他病变,对其采取3种不同手术径路切除,即经上颌窦自然口径路切除58例,经下鼻道开窗径路切除39例,经上颌窦前壁径路切除53例,评价3种径路的治疗效果。结果：150例患者,经过6～12个月的随访,术后鼻腔通气良好,面部胀痛、头痛、头昏等临床症状消失,经鼻内镜及鼻窦CT检查,无脓性分泌物,无囊肿复发。结论：根据上颌窦囊肿位置类型及伴有的疾病不同,鼻内镜下选择不同径路手术,上颌窦囊肿的术后康复效果更理想。     

保存性外科治疗突入上颌窦后份牙源性囊性病变疗效评价

目的通过临床、影像随访综合评价保存性手术治疗上颌窦后份牙源性囊肿的手术成功率,探讨其有效性和优缺点。方法回顾2011年12月—2014年12月施行保存性手术治疗牙源性上颌窦囊性病变的患者,进行临床和影像学随访和评价。两者评价均分为优、良、差3级,将优和良视为手术有效。采用SPSS 17.0软件包中的Fisher确切概率法,比较临床和影像评价的有效率是否具有差异。结果21例患者施行保存性手术,19例接受随访。随访期为3~31个月（平均14.4月）。术后1例患者发生感染,手术成功率为94.74%（18/19）;2例出现暂时性面部和牙轻度感觉异常,3个月后均恢复正常;均无鼻窦症状及面部畸形和永久性面部麻木等并发症;1例牙源性角化囊性瘤术后7个月复发,重行保存性手术,随访11个月后无复发;螺旋CT复查见上颌窦黏膜腔有不同程度增大,窦壁有新骨形成,上颌窦炎消失或好转。结论保存上颌窦黏膜及骨板不但手术成功率高,并发症少,而且有利于保存上颌窦的生理功能和黏膜腔体积扩大,保持上颌骨外形。     

鼻内镜在治疗牙断根误入上颌窦中的应用

目的 探讨应用鼻内镜取出误入上颌窦的牙断根的方法.方法 对18例牙断根误入上颌窦患者采取经上颌窦前壁开窗、鼻内镜取出断根的治疗方法,同期以腭黏骨膜瓣修复上颌窦穿孔.结果 18例患者均一次手术取出断根,操作时间(不包括腭黏骨膜瓣修复)为15～25 min.观察3个月无继发上颌窦炎或口腔上颌窦瘘.结论 经上颌窦前壁开窗,用鼻内镜取出误入至上颌窦的牙断根是一种快捷有效的方法.     

开窗减压术治疗大型牙源性角化囊性瘤的临床研究

目的 :探讨开窗减压术治疗颌骨大型牙源性角化囊性瘤的临床价值。方法 :对22例牙源性角化囊性瘤进行开窗减压术,定期随访,待囊腔直径缩小至1~2 cm或连续观察3个月无明显变化时,行二期囊肿刮除术。结果:开窗减压期为3~24个月,影像学显示囊腔周围新骨再生,颌骨形态改建。二期刮除术后随访6~48个月,无复发病例。结论:开窗减压术是一种安全、有效微创治疗颌骨大型牙源性角化囊性瘤的方法。     

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。     

开窗减压术治疗大型上颌窦牙源性囊性病变疗效评价

目的：评价开窗减压术治疗大型上颌窦牙源性囊性病变的疗效,为临床治疗提供参考。方法：回顾2011年1月—2020年12月于上海交通大学医学院附属第九人民医院口腔外科就诊的大型牙源性上颌窦囊性病变病例,采用开窗减压后二期刮治手术治疗,开窗后配戴塞治器,分为负压及非负压引流2种。应用Mimics定量测量病变体积变化,观察新骨改建、上颌窦炎症情况。采用SPSS 17.0软件包,通过配对t检验比较术前囊性病变和最终二期手术前囊性病变体积是否存在差异,通过成组t检验和卡方检验比较不同塞治器治疗效果。结果：20例患者纳入研究,负压及非负压引流各10例。开窗前囊性病变体积为(25 993.81±13 611.78)mm³,减压后最终体积为(5 386.30±3 546.30)mm³,体积缩小率为(77.54±13.01)%,缩小显著(P<0.001)。11例病变体积缩小>80%,9例介于50%～80%之间。非负压吸引组体积缩小率为(72.75±14.16)%,疗效优秀率40%;负压吸引组体积缩小率为(82.33±10.29)%,疗效优秀率70%,...     

波及上颌窦的大型颌骨囊肿的治疗及临床效果

目的:探讨侵犯上颌窦的大型颌骨囊肿的治疗和临床效果。方法 :回顾2007-07—2015-03期间,在本院治疗的72例侵犯上颌窦的颌骨囊肿患者。A组(n=36)术中联合用超声骨刀和鼻内镜,彻底清除病变组织,保存正常窦内黏膜及骨骼外形;B组(n=36)术中用骨凿、咬骨钳去除骨壁,摘除囊壁组织后用刮匙搔刮囊腔及行上颌窦根治术。术后随访观察3~72个月,对术后并发症进行对比观察和统计学分析。采用SPSS13.0软件包对数据进行χ2检验。结果:A组患者在上颌窦瘘、面部畸形、鼻通气功能方面,术后并发症发生率显著低于B组(P<0.05);颌面部的美观和功能恢复良好。结论:术中用超声骨刀和鼻内镜治疗侵犯上颌窦的大型颌骨囊肿,保存正常窦内黏膜及骨骼外形,可明显降低上颌窦瘘和鼻通气下降的发生,颌面部的美观和功能恢复较满意。     

内镜辅助等离子射频消融手术治疗牙源性上颌窦炎近期疗效观察

目的:探讨采用内镜辅助下等离子射频消融手术治疗牙源性上颌窦炎的效果。方法:回顾性分析35例牙源性上颌窦炎患者的资料。其中采用内镜辅助下等离子低温射频治疗患者23例,手术从患侧上颌窦前壁开窗,鼻内镜经中鼻道开口或在开窗处进路,在内镜下探查炎症病灶的具体部位,在去除病灶牙的同时,应用等离子低温射频对上颌窦内病变黏膜部分进行多点消融。其他12例患者采用柯-陆手术治疗,比较2种方法的治疗效果。结果:采用柯-陆手术患者平均住院天数11d,12例患者术后面颊肿胀明显,7例出现面部麻木,6例出现牙疼痛。采用内镜辅助下等离子射频消融手术患者平均住院5d,且未出现上述并发症。内镜辅助射频治疗组术后3个月鼻道窦口完全恢复通畅。35例患者随访3个月时未见复发。结论:与柯-陆手术相比,采用内镜辅助下等离子低温射频消融手术治疗牙源性上颌窦炎在去除病灶的同时,减少了上颌窦黏膜和骨质的损伤,减少患者住院时间,利于术后恢复,临床疗效肯定。     

牙源性角化囊肿袋形术后的骨形成与改建

目的：本研究的目的是评价颌骨牙源性角化囊肿袋形术后骨形成的特点。方法：65例牙源性角化囊肿患者采用袋形术治疗。术后第3和第6个月分别进行临床、x线检查。病变范围广泛或曲面体层片上显示骨皮质破坏的患者补充CT检查。评估囊肿大小、皮质板穿通、下颌管的连续性、囊内牙移位及患区骨密度变化等。结果：在术后3个月,皮质板破坏区的骨连续性重新建立,下颌管的连续性部分恢复,变形的下颌骨呈现改建。囊内含牙随着囊肿的缩小而发生位移或部分萌出。曲面体层片显示,囊肿区骨密度值不断增加,术后3个月46．07％,术后6月达到64．69％。结论：牙源性角化囊肿袋形术后头3个月患区骨再生较快,一部分解剖形态恢复,此后新骨形成相对较慢,骨改建仍在进行。     

Endoscopic sinus surgery for dental implant displacement into the maxillary sinus—a retrospective clinical study

The aims of this retrospective clinical study were to present our management protocol for the retrieval of impacted dental implants that have become displaced into the maxillary sinus cavity and to define the role of endoscopic sinus surgery in this setting. All 24 patients (25 implants) who underwent surgical retrieval of dental implants displaced into the maxillary sinus between 2012 and 2019 were included. Data on surgical interventions and complications were collected retrospectively. Eleven patients (46%) had chronic sinusitis associated with the migrated implant. All implants were successfully retrieved via transnasal endoscopic approach alone: 80% via a middle meatal antrostomy and 20% via a combined middle and inferior meatal antrostomy. Five patients required a concomitant transoral approach for oro-antral fistula repair. None required a transoral approach for displaced implant retrieval. All patients healed uneventfully without complications. Transnasal endoscopic sinus surgery via a middle meatal antrostomy or a combined middle and inferior antrostomy is recommended as the primary choice for dental implant retrieval from the maxillary sinus. A transoral approach should be performed simultaneously only for oro-antral fistula repair. This surgical protocol proved to be safe and efficient, and it obviated the need for osteotomies of the anterolateral maxillary wall.     

Endonasal endoscopic approach for recurrent nasolabial cyst

ABSTRACT: Nasolabial cysts are rare nonodontogenic cystic lesions in the soft tissue of the midface and usually present with painless asymptomatic swelling in the nasolabial region. Surgical excision via sublabial approach is considered as the standard treatment. However, endonasal endoscopic marsupialization of the cyst is reported as an effective alternative method for nasolabial cysts. Marsupialization of the cyst is believed to integrate the nasolabial cyst into a part of the nasal cavity as an air-containing sinus. In this article, we present an endonasal endoscopic marsupialization technique in case of recurrent nasolabial cyst. To draw attention to this approach, we present our case with current literature.     

Clinicopathologic features of dentigerous cysts in the maxillary sinus

Dentigerous cyst (DC) in the maxillary sinus is extremely rare. This study evaluated the clinical features, etiologic factors, imaging, treatment, and signs and symptoms of this type of DC. Clinical symptoms, radiographic findings, surgical methods, and histopathologic findings of 4 patients with DCs in the maxillary sinus were evaluated. In addition, we reviewed the literature reports of DCs in the maxillary sinus over the past 40 years. Our 4 patients with DC in the maxillary sinus showed the following results: (1) all the patients were males at first 3 decades of age, (2) swelling and/or yellow-green pus discharges from pharyngeal cavity were common symptoms, (3) the involved teeth in the DC were the maxillary third molar teeth and supernumerary teeth, and (4) Caldwell-Luc approach was performed in these 4 patients. The patients with DC in the maxillary sinus should be evaluated thoroughly by extraoral and intraoral examinations, proper diagnostic imaging procedures, and pathologic examination to avoid misdiagnosis of maxillary sinusitis. The standard treatment for DC in the maxillary sinus is often removed by Caldwell-Luc approach. Furthermore, marsupialization or functional endoscopic sinus surgery may be performed because of the size, location of the cysts, or the age of the patients.     

EGCG开窗灌洗治疗颌骨牙源性角化囊性瘤的临床疗效

目的应用EGCG(表没食子儿茶素没食子酸酯,epigallocatechin-3-gallate,EGCG)开窗灌洗治疗颌骨牙源性角化囊性瘤,观察其临床疗效。方法 18例颌骨牙源性角化囊性瘤患者,行局部开窗,并制作引流口保持器,分为2组:8例应用EGCG溶液灌洗囊腔,10例应用生理盐水灌洗囊腔。术后定期复诊,每2个月行曲面体层片及CT检查,观察比较两组囊腔变化情况,囊腔长径小于2 cm时行二期手术刮除残余囊壁。结果 EGCG溶液灌洗病例,开窗灌洗6~10月后囊腔即缩小至长径小于2 cm,行二期刮除手术。生理盐水灌洗病例,需10~16月囊腔缩小至长径小于2 cm,可行二期刮除手术。EGCG灌洗病例的临床疗程较生理盐水灌洗组明显缩短,差异有统计学意义,P<0.05。结论 EGCG开窗灌洗可明显缩短颌骨牙源性角化囊性瘤的治疗周期。     

8例青少年沙瘤样骨化纤维瘤临床分析

目的: 分析青少年沙瘤样骨化纤维瘤（juvenile psammomatoid ossifying fibroma, JPOF）的临床及影像学特点、治疗方法和预后。方法: 收集2016 年 2月—2020 年 10 月收治的8 例JPOF患者的临床及影像学资料,并进行随访,总结其临床表现、影像学特征、治疗和预后情况。结果: 8例JPOF患者,男4例,女4例,年龄（14.1±7.9）岁;发生于下颌骨3例,筛窦2例,上颌骨（窦）1例,鼻腔1例,额窦1例;病灶大小为（37.0±9.7）mm,临床表现以鼻塞、流涕、局部膨隆和疼痛多见。CT显示为蛋壳样骨壳包绕着圆形或类圆形内核的占位性病变,MRI呈现为混杂信号的囊实性肿瘤。8例JPOF均采用手术治疗,筛窦、上颌骨（窦）及鼻腔患者于鼻内镜下行病灶刮除联合周围骨磨除;额窦患者行开放性手术病灶刮除联合周围骨磨除;2例下颌骨JPOF患者行刮除术并磨除周围部分骨质,半年后复发,即再次手术;1例下颌骨JPOF患者行下颌骨节段性切除,并应用血管化髂骨肌复合组织瓣修复。随访至今均未见复发。结论: JPOF是一种发生于青少年且极为罕见的良性骨纤维性肿瘤,临床及影像学特点无特异性,主要依靠病理检查诊断,生长具有一定侵袭性,治疗方法为病灶刮除联合周围骨磨除。     

Evaluation of maxillary sinus after treatment of midfacial fractures.

PURPOSE: Maxillary sinuses are the most frequently injured anatomic region of the facial skeleton in midfacial fractures. The purpose of this study was to evaluate the patients with maxillary sinus wall fractures using clinical examinations, maxillofacial computed tomography (CT), and cranial bone single-photon emission tomography (SPECT) and to interpret the results of these examinations to evaluate the indications of surgical intervention or drainage for maxillary sinus after maxillary sinus wall fractures. MATERIALS AND METHODS: The results of examinations of 15 patients with maxillary sinus fractures who were treated for midfacial fractures were evaluated. Follow-up examinations were performed in the range of 3 to 47 months after surgery (average, 19.8 months). The patients ranged in age from 10 to 45 years, with an average age of 31.6 years. There were 11 male and 4 female patients. Seven patients had Le Fort II fractures, 6 patients had tripod zygomatic fractures, 1 patient had infraorbital fracture, and 1 patient had zygomatic arch fracture. Operative procedure was performed in all cases. To evaluate maxillary sinus after surgery, maxillofacial computed tomography (CT), cranial bone SPECT, and maxillary sinusitis evaluation form were used in all patients. RESULTS: Maxillofacial CT scans were related to sinusitis in 9 patients who had positive complaints for sinusitis. The cranial bone SPECT showed positive uptake at the fractured sites in 8 patients, minimal uptake in 2 patients, and normal uptake in 5 patients. CONCLUSIONS: Clinical examination, maxillofacial CT, and cranial bone SPECT are the most reliable methods available today for the diagnosis and follow-up of complications of maxillary sinus fractures.     

Different endoscopic strategies in the management of recurrent sinonasal inverted papilloma

Sinonasal inverted papilloma (IP) is noted for its high rate of recurrence. Although many clinical studies have demonstrated the effectiveness of the endoscopic approach for IP, only a few published reports have studied the efficacy of endoscopic surgery for recurrent IP, and the surgical approach has been the subject of much debate. In this study, our objective was to demonstrate the effectiveness and limitations of 3 different endoscopic procedures used for the treatment of recurrent IP. From January 2001 to June 2008, 26 patients with recurrent IP were treated with endoscopic surgery. Previous surgeries included 5 cases of lateral rhinotomy and 21 cases of endoscopic endonasal surgery. With preoperative computed tomography or magnetic resonance imaging, we attempted to identify the sites of origin and attachment of IP. Three types of resection were used: basically, purely endoscopic endonasal resection was used for tumors arising from lateral nasal wall, ethmoid sinus, and frontal sinus; endoscope-assisted medial maxillectomy was used for tumors originating from the medial wall of the maxillary sinus; and the combination of the endoscopic and Caldwell-Luc procedure was used for tumors involving the anterior, inferior, superior, or lateral portion of the maxillary sinus. Efficacy was evaluated strictly by endoscopic examination or computed tomography in a mean follow-up of 28.2 months (range, 13-42 mo). Three types of procedure were performed in 6, 10, and 10 patients, respectively. Three patients had residual recurrence within 2 months after the resection. One tumor was confirmed malignant. There were no major complications encountered in the patients. In conclusion, different endoscopic strategies are modulated in relation to the attachment of recurrent tumor. The purely endoscopic endonasal procedure is suited for the treatment of recurrent IP limited to the nasal cavity, the ethmoid sinus, and the frontal sinus. As to tumors arising from the maxillary sinus, medial maxillectomy or an additional Caldwell-Luc surgery should be performed.