53例牙源性上颌窦炎功能性治疗和疗效评价

目的: 分析牙源性上颌窦炎治疗方法并评价其疗效,为临床诊治提供参考。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就诊的53例牙源性上颌窦炎(odontogenic maxillary sinusitis, OMS)患者的临床资料。采用去除各种牙源性病灶、保存窦黏膜和牙槽骨的功能性手术治疗OMS。应用Lund-Mackay评分法定量评价手术前、后上颌窦炎,采用SPSS 17.0软件包中的配对t检验比较手术前、后Lund-Mackay均值差异。另外,评估术后反应及术后并发症情况。结果: OMS常见病因为牙源性囊性病变 (49.05%)、根尖炎 (20.75%)、口腔-上颌窦瘘(16.98%) 和异物 (13.21%)。功能性手术后患者上颌窦炎恢复明显,Lund-Mackay评分术前为3.72±0.51,术后为0.05±0.32,评分显著下降 (P<0.001)。术后反应小,无严重并发症发生。结论: 治疗OMS应着重处理牙源性病灶,行功能性手术,保护上颌窦黏膜。

Functional treatment and efficacy evaluation of odontogenic maxillary sinusitis in 53 consecutive patients

PURPOSE: To analyze the therapeutic methods of odontogenic maxillary sinusitis(OMS) and evaluate its efficiency, and to provide reference for clinical diagnosis and treatment. METHODS: Fifty-three cases of OMS at Shanghai Ninth People's Hospital from January 2011 to December 2020 were reviewed, and the etiology and constituent ratio were summarized. OMS was treated by functional surgery to remove various odontogenic lesions and preserve sinus mucosa and alveolar bone. The preoperative and postoperative maxillary sinusitis were quantitatively evaluated by Lund-Mackay scoring method, and the mean difference of Lund-Mackay before and after operation was compared by paired t test using SPSS 17.0 software package. In addition, the postoperative reactions and complications were evaluated. RESULTS: The common causes of OMS were odontogenic cystic lesions(49.05%), apical inflammation(20.75%), oral maxillary sinus fistula (16.98%) and foreign bodies (13.21%). The Lund-Mackay score was 3.72±0.51 before operation and 0.05±0.32 after operation, which decreased significantly(P<0.001). The postoperative response was small and there was no serious complication. CONCLUSIONS: The treatment of OMS should focus on the elimination of odontogenic lesions. Functional surgery was recommended to protect maxillary sinus mucosa.