保存牙槽骨的上颌窦内异物取出方法及临床评价

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (2): 154-157.

保存牙槽骨的上颌窦内异物取出方法及临床评价

胡颖恺, 杨驰, 徐光宙, 汪湧, 郑凌艳

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,上海市口腔重点实验室,上海 200011

收稿日期:2015-03-20 出版日期:2016-03-20 发布日期:2016-04-06
通讯作者: 杨驰,E-mail:yangchi63@hotmail.com
作者简介:胡颖恺（1990-）,女,在读硕士研究生,E-mail:1010270262@qq.com
基金资助:
上海市卫生局资助项目（20134102）; 上海市科学技术委员会科研计划项目（14DZ2294300; 上海市科学技术委员会学科带头人计划（13XD1402300））

Retrieval of foreign bodies in maxillary sinus via antereolateral wall of the sinus to preserve alveolar bone

HU Ying-kai, YANG Chi, XU Guang-zhou, WANG Yong, ZHENG Ling-yan

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

Received:2015-03-20 Online:2016-03-20 Published:2016-04-06

摘要/Abstract

摘要： 目的:介绍一种通过上颌窦前外侧壁取出上颌窦内异物的方法,以保存牙槽骨,并评价其临床疗效。方法:收集2011年8月—2014年12月期间牙根等异物误入上颌窦的患者。记录牙位、病程、口腔-上颌窦瘘直径、治疗经过。拍摄全景片及CT后,采用超声骨刀经上颌窦前外侧壁开窗,根据异物位置和大小决定开窗大小,异物位置深在时则以内镜辅助定位。小开窗不复位骨板,大开窗复位骨板,以钛板固定。记录手术结果和时间、术后反应、口腔-上颌窦瘘愈合情况,以及并发症情况。结果:共取出12例进入上颌窦的异物,4例应用内镜辅助定位,3例做小开窗,9例做大开窗,异物均成功取出,手术时间少于20 min。术后疼痛时间平均5.7 d,肿胀时间平均14.3 d,3例出现0.5~5 d鼻腔渗血;牙槽骨形态丰满;口腔-上颌窦瘘均一期愈合;无面部麻木及感染。结论:应用该方法取出误入上颌窦异物的成功率高,具有微创、视野清楚、省时、并发症少等优点,值得推广。

关键词: 上颌窦, 异物, 骨板复位, 超声骨刀, 内镜

Abstract: PURPOSE: This study was aimed to present a functional surgery for the retrieval of displaced root fragment from the maxillary sinus to preserve the alveolar bone, and evaluate its efficiency. METHODS: Patients with foreign bodies displaced into the maxillary sinus referring to our department were collected from 2011.8 to 2014.12. The tooth of each patient, the delay between displacement and retrieval, the oroantral communication (OAC), and previous treatment procedures were recorded. After examination of orthopantomograms and computed tomograms, all patients underwent surgery to create a bone window from anterolateral wall of the maxillary sinus using piezosurgery, and repositioned with micro-plates after removal of foreign body and lesions in the sinus if the lid was large. In case the foreign body was barely detectable, endoscopy was used to help localization. The length of operating time, the duration of pain and swelling, the condition of alveolar ridge, OAC and maxillary sinus, as well as complications were assessed with clinical and imaging examinations. RESULTS: Twelve foreign bodies were extracted successfully, 4 with the help of endoscopy. Nine bone windows were repositioned while 3 others were not, the operations were completed in 20 minutes. Pain disappeared within 5.7 days on average, and swelling lasted for 14.3 days. Nasal bleeding occurred in 3 patients lasting for 0.5 to 5 days. The amount of alveolar bone loss was small and all the OACs were healed well. No patients developed complications such as facial paresthesia, facial asymmetry and infection. CONCLUSIONS: This surgery for the retrieval of displaced root fragment from the maxillary sinus is worthy of wide clinical use due to high successful rate, quick recovery, preservation of alveolar bone and minimal complications.

Key words: Maxillary sinus, Foreign bodies, Bony window reposition, Piezosurgery, Endoscopy

中图分类号:

R782.1

胡颖恺, 杨驰, 徐光宙, 汪湧, 郑凌艳. 保存牙槽骨的上颌窦内异物取出方法及临床评价[J]. 中国口腔颌面外科杂志, 2016, 14(2): 154-157.

HU Ying-kai, YANG Chi, XU Guang-zhou, WANG Yong, ZHENG Ling-yan. Retrieval of foreign bodies in maxillary sinus via antereolateral wall of the sinus to preserve alveolar bone[J]. China J Oral Maxillofac Surg, 2016, 14(2): 154-157.

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