突入上颌窦的囊性病变85例CT分析

Location and differential diagnosis of odontogenic cysts intruding into maxillary sinus

目的 :探讨牙源性上颌窦囊性病变部位及其鉴别诊断,以提高术前诊断的准确率,指导手术方案。方法 :回顾2011年12月—2014年12月就诊于上海交通大学医学院附属第九人民医院口腔外科经螺旋CT诊断为牙源性囊性病变侵及上颌窦的患者,统计上颌窦前外、后、内、下、上5个壁被侵犯的比例。筛选其中有病理诊断者,分析其影像学表现,并结合临床表现进行病种总结和鉴别诊断。结果:85例突入上颌窦的牙源性囊性病变中,侵及上颌窦下壁和后壁者最多。含牙囊肿、根尖囊肿、牙源性角化囊性瘤多见,有2例影像学诊断为成釉细胞瘤,但病理检查为黏液表皮样癌和腺样囊性癌。结论:牙源性囊性病变多侵及上颌窦后壁和下壁,需依赖影像、临床表现和病理检查三者结合,以做出准确诊断。

PURPOSE： This study was aimed to review the location and differential diagnosis of odontogenic cysts intruding into maxillary sinus, in order to improve accuracy rate of preoperative diagnosis and guide operation planning.METHODS： Cases of odontogenic cysts intruding into sinus diagnosed by spiral CT from 2011.12 to 2014.12 at the Department of Oral Surgery, Shanghai Ninth People＇s Hospital were reviewed. The proportion of each sinus wall being invaded was counted using spiral CT images. Then selecting the ones with pathologic diagnosis and analyzing their CT images, along with clinical manifestation to summarize the entities and differential diagnosis of odontogenic cysts.RESULTS： A total of 85 cases were included, the inferior and posterior walls of the sinus were most frequently invaded,and the top three disease entities were dentigerous cyst, radicular cyst and odontogenic keratocystic tumor. Two cases diagnosed as ameloblastoma but turned out to be adenoid cystic carcinoma and mucoepidermoid carcinoma after pathological examination. CONCLUSIONS： Odontogenic cysts often intrudes into inferior and posterior walls of maxillary sinus, diagnosis should depend on CT images and pathological examinations, as well as clinical manifestation.