鼻内镜下犬齿窝径路治疗上颌窦病变

Some experience of the endoscopy treatment of maxillary sinus lesion with the canine tooth fossa approach

目的：探讨一个损伤少，方便快捷且效果好的鼻内镜下的上颌窦手术方案治疗上颌窦病变。方法：2002年3月至今，设计在患侧唇龈沟第三齿上方做一纵形切口1～1．5cm，分离至犬齿窝骨质，用骨凿或电钻做1cm左右的骨孔，清除此处的上颌窦黏膜，置入鼻内镜，检查上颌窦内的病变情况，如果为上颌窦黏膜下囊肿，去除囊壁，妥善止血；上颌窦自然窦口正常者，无须扩大窦口，在上颌窦内的创面上和犬齿窝骨窗处贴附止血纱布，缝合2针，也可以应用耳脑胶粘合。如果为上颌窦息肉，处理方法基本同上颌窦囊肿。如果为上颌窦曲茵病，就需要扩大上颌窦自然窦口1～1．5cm，鼻腔内可不必填塞，如需扩大自然窦口，可填塞膨胀海绵。结果：36例均一期愈合，鼻腔通畅，症状消失，经过4个月～4年的随访观察，未见病变复发。仅2例有短暂的唇部麻木，7～8d后康复。2例扩大自然窦口处有肉芽生长，经处理后肉芽消失。结论：本术式有视野清晰，处理病变方便，并发症少，不宜发生严重的反应，窦口引流自然，符合上颌窦黏膜的正常生理特点。

Objective： Operation in the maxillary sinus tends to injure the debouchement of the nasolacrimal canal in the inferior nasal meatus and the walls of the fossa orbitalis. We tried to find a program with the least injury, duration and that was the most convenience. Methods： From March 2002 to the present, we designed an upright cut of 1 to 1.5 cm in the side labiogingival groove of the ill side above the canine tooth, separated to the bone in canine fossa, drilled a hole of 1 cm with an osteotome or electrodrill, removed the local mucosa, inserted an endoscope, and inspected the lesions inside. If submucous cysts were found, the capsule wall was remdved and proper hemostasis was performed; if the mucosa was normal, there was no need to enlarge the aperture, an absorbable hemostatic gauze was laid in the wound surface and the hole, and sutured with 2 stitches; or adhered with biological glue. In patients with an antral polyp, the management was the same as the cases with sumucosa cyst. In patients with aspergillosis, we enlarged the apertures to 1-1.5 cm, did not pack the nasal cavity, if we enlarged the apertures, we may pack expansive sponge. The face was oppressed with a four head belt, the plug was taken out after 48 or 72 hours according to the pathogenetic condition, and stitches were taken out after 4 or 5 days. Results： Primary healing was found in all 36 cases, with an unobstructed nasal cavity and disappearance of the symptom. No relapse was found in the period of four months to four years of followup; only 2 cases complained about transient numbness in the upper hps. All patients recovered after 7-8 days. ,Granulations were found in the enlarged aperture in 2 cases, and they disappeared after treatment. Conclusion： The feature of the operation is the small upright cut in the labiogingival grooves, small windowing in canine fossa, and delicate operation in the sinus cavity with a clear visual field. Lesions may be treated conveniently, which lead to less complications and less severe reactions. The maxillary sinus drains naturally, accords to the normal physiological functions and also problems are avoided that happen in other approaches.