经鼻内镜开窗术治疗侵犯上颌窦的大型上颌骨囊性病变

Transnasal endoscopic marsupialization of large cystic lesions with maxillary sinusal extension

目的：探讨经鼻内镜开窗术治疗侵入上颌窦的大型牙源性上颌骨囊性病变的应用价值。方法 ：对21例侵犯上颌窦的牙源性颌骨囊性病变（直径3.5~6 cm）患者行经鼻内镜开窗术,术后通过临床检查、鼻内镜及CT检查随访1.5~3 a。结果：3个月内,面部恢复对称,鼻塞等症状消失。3个月后,鼻内镜下检查见鼻开窗口边缘的囊壁残缘与鼻底黏膜自然愈合,开窗口呈不同程度的缩小。CT复查发现,上颌窦与囊性病变融为一体。囊壁回缩,囊腔破坏的骨质出现再生,12个月后改建成接近正常的上颌窦。所有患者囊性病变未复发。结论：经鼻内镜开窗术是治疗侵入上颌窦的大型牙源性上颌骨囊性病变的有效方法。

PURPOSE： To evaluate the feasibility and clinical value of endoscopic marsupialization of large cystic lesions with maxillary sinusal extension. METHODS： Transnasal endoscopic marsupialization was performed in 21 patients with maxillary cystic lesions that extended to the maxillary sinus. The lesions were 3.5-6 cm in size, the patients were followed up for 18-36 months. Clinical examination, nasal endoscopy and CT scans were performed postoperatively. RESULTS： In21 patients, the cystic lesions completely resolved both clinically and radiographically. No recurrence was observed during follow up. Within 3 months, all patients showed signs of healing and facial swelling disappeared. Three months after surgery, epithelization of the cystic cavity was found in the ＂window＂. CT scans demonstrated the cystic lesions and maxillary sinus fused into a big cavity, bone regeneration in the maxillary wall. The appearance of the maxillary sinus mucous membrane turned to normal. Followed-up CT scans revealed restoration of the maxillary sinus to almost normal condition. CONCLUSIONS： Transnasal endoscopic marsupialization can be a definitive treatment for large cystic lesions with extension in the maxillary sinus.