牙源性上颌窦炎的锥形束计算机体层摄影分析

Cone beam computed tomography for odontogenic maxillary sinusitis

目的通过锥形束计算机体层摄影(cone beam computed tomography,CBCT)分析牙源性上颌窦炎的特点。方法回顾性分析于我院就诊的500例患者的CBCT影像资料,测量双侧上颌窦黏膜厚度,记录黏膜增厚部位相邻牙病变情况及其牙根与上颌窦底的关系。结果牙源性上颌窦炎在上颌窦炎中占27.5%,在>59岁的男性患者中发现率最高(P<0.01),病因中根尖周疾病所占比例最大。有35%的病原牙引起了牙源性上颌窦炎,牙根进入上颌窦的病原牙(A类)和牙根位于窦底的病原牙(B类)引起上颌窦炎的概率比牙根距窦底有一定距离的病原牙(C类)高(P<0.01),A类和B类之间差异无统计学意义(P>0.05)。结论 CBCT有助于分析上颌窦炎与牙病间的可能因果关系;牙源性上颌窦炎在老年男性患者中发现率相对较高;当存在牙根距上颌窦较近的根尖周疾病患牙时需警惕牙源性上颌窦炎的存在。

Objective To explore the ratio of odontogenic maxillary sinusitis（ OMS） in maxillary sinusitis patients in dental clinic,the main causes,and the relationship between OMS and the roots of pathogenic tooth using cone beam computed tomography（ CBCT）. Methods Through analysis and measurement of 500 CBCT scans of dental clinic,the maxillary sinusitis mucosal thickness and the causes of OMS were recorded,as well as the anatomic relationship between the roots and the floor of maxillary sinus.Results Among the maxillary sinusitis patients,27. 5% of OMS was detected,and the incidence was more frequent in the patients of 〉59 years old（ P〈0. 01）. Meanwhile,periapical periodontitis was found to be the main cause. The OMS was caused by pathogenic teeth in 35% patients. The probability that pathogenic teeth whose root tips entered the sinus floor（ category A） or touched the sinus floor（ category B） caused maxillary sinusitis was higher than the probability that pathogenic teeth having gap or space with the sinus floor（ category C） caused maxillary sinusitis（ P〈0. 01）,but there was no statistically difference between category A and B（ P〉0. 05）. Conclusion The probable causal relationship between OMS and odontopathy can be displayed well with CBCT. The incidence of OMS in chronic maxillary sinusitis is relatively high in the elderly male patients. In the periapical disease with pathogenic teeth whose roots are close to the floor of maxillary sinus,OMS needs to be given more attention.