鼻内开窗术治疗巨大上颌骨囊肿的临床察

目的探讨鼻内开窗术治疗巨大上颌骨囊肿的临床疗效。方法选择术前穿刺并且经鼻窦CT及MRI检查诊断为上颌骨囊肿的患者5例，囊肿均大于3.5 cm，所有患者采用鼻内镜下鼻内开窗术，根据囊肿与鼻腔、鼻窦的毗邻关系，分别选择鼻底开窗术、下鼻道开窗术，必要时行泪前隐窝开窗术，手术切除囊壁，其中2例患者因囊肿局限、主要靠近鼻底而选择单纯鼻底开窗术；2例患者因囊肿波及上颌窦内而选择下鼻道开窗术，其中1例术前因牙痛就诊，术后建议拔除患牙；1例患者因囊肿位置特殊，靠近上颌窦前壁因而行下鼻道开窗术联合泪前隐窝开窗术，对位缝合切口，术后予以碘仿纱条压迫及盐水冲洗，清理术腔，保证开窗口通畅引流。结果5例患者均未出现严重并发症，术后3个月左右囊腔上皮化，术后随访半年，窗口引流通畅，未见复发。结论鼻内开窗术是一种简单并且常用的手术方式，具有出血少、创伤小、复发率低等优点，保证开窗口通畅引流是减少上颌骨囊肿复发的关键。

Clinical observation on the treatment of giant maxillary bone cysts with intranasal fenestration

ObjectiveTo investigate the clinical effect of the treatment of giant maxillary bone cysts with intranasal fenestration.MethodsFive patients with maxillary bone cyst were selected and diagnosed by preoperative puncture through nasal sinus CT and MRI. All giant maxillary bone cysts of 5 cases were larger than 3.5 cm. All patients were treated with intranasal fenestration under nasal endoscope. According to the location of maxillary cysts in nasal cavity and sinus, the giant maxillary cysts were treated with the nasal floor fenestration and the inferior nasal meatus fenestration respectively, or the anterior lacrimal crypt fenestration if necessary.The walls of the cysts were removed surgically. Two patients of them with limited cysts were chosen simple fenestration of nasal base because cyst was mainly close to nasal base. Two patients were chosen maxillary sinus fenestration via the lower nasal passage because their cysts were involved in the maxillary sinus.One patient visited the doctor before surgery for toothache, who was recommended postoperative extraction of the affected tooth. One patient was performed the fenestration of inferior nasal meatus combined with fenestration of anterior lacrimal recess due to the special location of maxillary cyst and its proximity to the anterior wall of maxillary sinus. Contrapuntal suture incision, and postoperative iodoform gauze compression and saline irrigation were performed to clear the operative cavity and maintain an unobstructed drainage.ResultsThere were no serious complications in all of the five patients. The cystic epithelialization occurred about 3 months after operation. The window drainage was unobtrusive during the follow up for half a year were recorded. No recurrence of all cases was observed.ConclusionsIntranasal fenestration is a simple and common surgical procedure, which has the advantages of less bleeding, less trauma and low recurrence rate. Maintaining an unobstructed drainage is the key to reduce the recurrence of maxillary bone cyst.