数字化辅助保存性外科治疗突入上颌窦后份的牙源性囊性病变

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (6): 522-526.

数字化辅助保存性外科治疗突入上颌窦后份的牙源性囊性病变

胡颖恺, 杨驰, 徐光宙, 王保利, 浦益萍

上海交通大学医学院附属第九人民医院·
口腔医学院口腔外科,上海市口腔医学重点实验室,上海 200011

出版日期:2016-11-20 发布日期:2016-12-05
通讯作者: 杨驰,E-mail:yangchi63@hotmail.com
作者简介:胡颖恺（1990-）,女,硕士研究生,E-mail:1010270262@qq.com
基金资助:
上海市科学技术委员会科研计划项目（14DZ2294300）; 上海市卫生局资助项目（20134102）

Digital design of conservative surgery for odontogenic cysts intruding into posterior part of maxillary sinus

HU Ying-kai, YANG Chi, XU Guang-zhou, WANG Bao-li, PU Yi-ping

Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine;Shanghai Key Laboratory of Stomatology. Shanghai 200011, China

Online:2016-11-20 Published:2016-12-05

摘要/Abstract

摘要： 目的寻求清除病灶的同时保存上颌窦黏膜和骨组织功能性的手术方法,应用数字化软件辅助设计手术方案,治疗突入上颌窦后份的牙源性囊性病变,并评价手术方法和术后反应。方法回顾2011年12月—2014年12月牙源性囊性病变突入上颌窦后份的21例患者。应用Mimics软件进行术前设计,根据病变体积和位置采用不同术式。术式1“开窗骨板复位法”适用于病变体积大,超过颧牙槽嵴,且上颌窦前外侧壁无明显骨质破坏者;术式2“去骨开窗法”适用于病变体积小,近颧牙槽嵴者。手术方法评价包括麻醉效果、出血情况、根据术前设计是否可顺利清除病灶以及手术时间等;术后评价包括疼痛、肿胀和骨板存活情况等。结果 15例采用开窗骨板复位法,6例采用去骨开窗法。均在20 min内成功完成手术,术中出血量少,术后疼痛时间平均为3.72 d;肿胀时间平均为7.67 d;8例术后鼻腔渗血1~3 d;1例患者术中见化脓性炎症,开窗骨板复位术后发生感染。CT复查见其余14例复位游离骨板均无明显吸收。结论治疗牙源性上颌窦囊性病变时,应尽量保存窦腔黏膜和骨板;数字化辅助设计手术方案可以准确指导术中截骨范围;化脓性炎症者不适宜行开窗骨板复位法。

关键词: 牙源性上颌窦囊性病变, 窦黏膜保存, 数字化设计, 骨板复位固定, 超声骨刀

Abstract: PURPOSE: To present a functional surgery for odontogenic cysts intruding into maxillary sinus to preserve the sinus mucosa and alveolar bone, and plan the surgery with assistance of digital design and evaluate postoperative outcomes. METHODS: Patients with odontogenic cysts intruding into posterior part of maxillary sinus were collected from December 2011 to December 2014 Different operations were chosen according to volume and location of the lesion with assistance of digital operative design. Method Ⅰ"fenestration and bone reposition" was suitable for large lesion exceeding zygomatic alveolar ridge but without apparent bone destruction of anterior wall of the sinus, while method Ⅱ "bone removal" was applied for small lesion near zygomatic alveolar ridge. Evaluation of operation methods included anesthetic effect, bleeding, lesion removal difficulties according to operative design and operation time. The duration of pain and swelling, and the condition of free bony wall were assessed postoperatively. RESULTS: Fifteen cases adopted method Ⅰwhile 6 underwent method Ⅱ. Operations were completed in 20 minutes smoothly. Pain disappeared in 3.72 days on average, and swelling resolved in 7.67 days on average. Nasal bleeding occurred in 8 patients lasting 1 to 3 days. Suppurative inflammation was observed in 1 patient, and infection occurred after bone reposition. Other repositioned free bony wall were without resorption on CT images. CONCLUSIONS: Sinus mucosa and bony wall should be conserved. Preoperative digital design can guide osteotomy effectively during the surgery. Bone reposition is not suitable for suppurative inflammation.

Key words: Odontogenic maxillary sinus cystic lesions, Sinus mucosa preservation, Digital design, Bony window reposition, Piezosurgery

中图分类号:

R782.1

胡颖恺, 杨驰, 徐光宙, 王保利, 浦益萍. 数字化辅助保存性外科治疗突入上颌窦后份的牙源性囊性病变[J]. 中国口腔颌面外科杂志, 2016, 14(6): 522-526.

HU Ying-kai, YANG Chi, XU Guang-zhou, WANG Bao-li, PU Yi-ping. Digital design of conservative surgery for odontogenic cysts intruding into posterior part of maxillary sinus[J]. China J Oral Maxillofac Surg, 2016, 14(6): 522-526.

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