鼻内镜经泪前隐窝入路手术治疗累及上颌窦含牙囊肿

Treatment of Dentigerous Cyst Involving Maxillary Sinus through the Frontal Recess of Tears Operation under Endoscope

目的:研究累及上颌窦含牙囊肿患者采用鼻内镜经泪前隐窝入路手术治疗的可行性和疗效。方法:选择于我科住院治疗的上颌窦含牙囊肿患者14例,并在术前对所有患者行鼻内镜、CT以及口腔全景片检查。术中先将上颌窦自然口扩大借以对上颌窦内病变情况进行评估,进而切开下鼻甲头端鼻腔外侧壁,将鼻泪管下端游离出来,使之形成下鼻甲瓣-膜性鼻泪管,将其向前固定后形成上颌窦入路,最后通过0度鼻内镜进行上颌窦内大部分囊壁的切除以及异位牙的取出。手术完毕后将下鼻甲以及鼻泪管复位并将切口缝合。观察所有患者术中情况和术后临床效果。结果:在鼻内镜直视下,所有患者的上颌窦各壁均能良好地显露,并最大程度地将囊肿壁清除,顺利地将异位牙取出。术后全部患者均无鼻腔出血、坏死、鼻甲萎缩、鼻泪管损伤、鼻腔干燥、溢泪以及面部感觉障碍等并发症。随访6-36个月,全部患者术后临床症状慢慢消退,上颌窦自然口无堵塞,引流通畅,下鼻甲形态良好未见异常,均未见囊肿复发。结论:经鼻内镜泪前隐窝入路具有视野好、创伤少,并发症少,是一种治疗累及上颌窦含牙囊肿患者的理想手术路径。

Objective： To investigate the feasibility and curative effect of dentigerous cyst at maxillary sinus through the frontal recess of tears operation under nasal endoscope. Methods： 14 patients with dentigerous cyst at maxillary sinus hospitalized in our department were examined with nasal endoscopy, CT and dental panoramic radiography before operation. During the operation, the natural ostium of maxillary sinus was firstly expanded to evaluate the lesion, and then the inferior turbinate head end of the lateral wall of the nasal cavity was cut. Separate the nasolacrimal canal in order to form the nasolacrimal duct-inferior turbinate flap. The maxillary sinus approach was formed after the fixation of the nasolacrimal duct-inferior mrbinate flap. Then 0 degree nasal endoscopic resection was used to remove most of the cyst wall and the allotriodontia in the maxillary sinus. Finally, the nasolacrimal duct- inferior turbinate flap was reset and the incision was sewed. The intraoperative and postoperative effects of all patients were observed. Results： Under nasal endoscopy, the maxillary sinus wall of all patients can be well exposed, and the cyst wall could be removed maximally, and allotriodontia removed successfully. After operation, all the patients had no complications like nasal hemorrhage, necrosis, atrophy of nasal turbinates, nasolacrimal duct injury, nasal dryness, epiphora and facial sensory disturbance. After 6-36 months of follow-up, all patients had their postoperative clinical symptoms subsided, with smooth drainage of ostia and good inferior turbinate shapes. There was no recurrence of the cyst. Conclusion： The frontal recess of tears operation under endoscope not only can make the wall of the maxillary sinus fully exposed, but also make less trauma and less complications. Patients had high quality of life after surgery. So it is the ideal surgical path to treat patients with dentigerous cyst at maxillary sinuses.