鼻内窥镜辅助下大型颌骨囊肿开窗减压并拔除埋藏智齿病例报告及文献复习

Case Report and Literature Review of Endoscopically Assisted Large Jaw Cyst Fenestration and Removal of Impacted Wisdom Teeth

目的:分析大型颌骨囊肿开窗减压术联合鼻内窥镜辅助下拔除低位埋藏智齿的临床应用效果。方法:选择9例大型颌骨含牙囊肿患者,自磨牙或磨牙后区或者磨牙后外侧前庭沟处开窗形成引流通道,在鼻内窥镜下联通各个囊腔并拔除因被囊肿挤压而低位埋藏的第三磨牙,术后以阻塞器维持开窗口并保持日常冲洗治疗,观察术后囊肿大小及囊壁周围骨质变化情况。结果:术后随访6-18个月,9例含牙囊肿治疗效果明显,有效率为100%。术后复查对比入院时均有不同程度的骨再生,囊腔皆有明显缩小,局部畸形及损伤也有不同程度恢复,其中3例均未行Ⅱ期刮治术,无复发。结论:颌骨囊肿的开窗治疗保留了颌骨的形态及功能,对于提升患者的生活质量效果明显;同时,鼻内窥镜在颌骨大型囊肿中引导连通各个囊腔以及拔除因囊肿移位的牙齿发挥了重要作用。

Objective:To investigate the clinical application of large-scale jaw cyst fenestration and the use of nasal endoscope for removing the low-impacted wisdom teeth.Methods:Nine patients with large jaw dentigerous cysts were treated with a drainage channel at the site of the molar or posterior molar or the posterior vestibular groove of the molar.The nasal endoscope was used to connect each pocket of cyst and remove the low-impacted wisdom teeth being squeezed by the cyst.The occluder was used to maintain the open window and keep daily flushing treatment.The size of the cyst and the bone changes around the wall were observed to evaluate the clinical effect of this method.Results:After 6-18 months of follow-up,the treatment of 9 cases of dentigerous cysts was effective,and the effective rate was 100%.Postoperative reexamination showed that the cystic cavity was significantly reduced.Local deformity and injury were also restored.None of the 3 patients underwent a secondary curettage and no recurrence was observed.Conclusion:The fenestration treatment of the jaw cyst preserves the shape and function of the jaw bone,and has obvious effects on the improvement of the quality of life of the patient.It is a clinically operative and therapeutically effective treatment method.In the meantime,nasal endoscope also plays a key role in guiding the connection of each pocket of cyst and extracting the impacted teeth displaced by the cyst.