上颌骨囊型骨纤维异常增殖症误诊一例并文献复习

A Misdiagnosed Patient with Maxillary Cystic Osteodysplasia Fibrosa and Literature Review

目的探讨上颌骨囊型骨纤维异常增殖症的临床特点、误诊原因,并提出防范对策。方法回顾性分析我院收治的1例上颌骨囊型骨纤维异常增殖症的临床资料。结果患者右侧上颌骨无痛性膨起2月余,曾先后就诊于3所医院,行X线片和CT检查。误诊为上颌骨囊肿、上颌窦囊肿等。我院术前诊断右侧上颌骨囊肿,全麻下行囊肿摘除术,术中见无囊肿存在,骨质松软,呈典型骨纤维异常增殖症样改变,改行Caldwell-luc术式完成手术。后病理证实术中诊断。结论上颌骨肿物在X线下表现为囊性透光阴影应考虑到囊型骨纤维异常增殖症可能。与上颌骨囊肿的主要鉴别有:①囊性阴影边缘不像上颌骨囊肿那样清晰完整;②穿刺抽不到囊液;③囊性阴影中可见舌状骨嵴自边缘伸入。

Objective To explore clinical characteristics and misdiagnosis reasons of maxillary cystic osteodysplasia fibro sa, in order to provide preventive countermeasure. Methods Clinical data of one patient with maxillary cystic osteodysplasia fibro sa in our hospital was retrospectively analyzed. Results The patient visited doctors of three hospitals for painless expansion in right maxilla for 2 months, and was misdiagnosed as having maxillary cysts, maxillary sinus cyst or other diseases by Xray and CT exami nations. In our hospital the diagnosis was right maxillary cysts before the operation. Cyst enucleation was performed under general anesthesia, no cysts were found during operation, the sclerotin was flaccid, which was the typical osteodysplasia fibrosa. The opera tive method was changed to Caldwellluc. The postoperative pathologic results confirmed the diagnosis. Conclusion Maxillary cyst ic osteodysplasia fibrosa should be suspected when maxillary mass shows cystic lucency shadow by Xray. The differences between maxillary cystic osteodysplasia fibrosa and maxillary cyst ： the edge of cystic shadow is not as clear and complete as that of maxillary cyst; no cyst fluid can be obtained by puncture; ligule ridge stretch into shadow from the edge can be seen in the cystic shadow.