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

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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。 OBJECTIVE: To seek the surgical method of preserving the function of the maxillary sinus mucosa and bone tissue while removing the lesion, to design digitalized software to design the surgical solution for the treatment of odontogenic cystic lesions of the posterior maxillary sinus, and to evaluate the surgical methods and postoperative response . METHODS: Twenty-one patients with odontogenic cystic lesions that broke into the posterior maxillary sinus were retrospectively reviewed from December 2011 to December 2014. Preoperative design using Mimics software, according to the lesion volume and location of different surgical procedures. Surgery 1 “window plate reset method ” for large lesions, more than the zygomatic alveolar crest, and the maxillary sinus anterior lateral wall without significant bone destruction; surgery 2 "boneless fenestration Suitable for small lesions, near the zygomatic alveolar crest. Surgical evaluation including anesthesia, bleeding, whether the preoperative design can successfully remove the lesion and the operation time; postoperative evaluation including pain, swelling and bone survival conditions. Results: In 15 cases, fenestration was used to restore the fenestration and 6 cases to be fenestrated. All successfully completed the operation within 20 min with less blood loss and an average duration of postoperative pain of 3.72 days. The average duration of swelling was 7.67 days. Eight patients had postoperative nasal leakage for 1-3 days. Inflammatory, fenestration reduction after infection. CT review found that the remaining 14 cases were no significant reduction of free bone plate absorption. Conclusions: In the treatment of odontogenic maxillary sinus cystic lesions, sinus mucosa and bone plate should be kept as much as possible. Digitally-assisted design of the surgical program can accurately guide the range of osteotomy in the operation; purulent inflammation is not suitable to open the window plate reduction method .
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