经口腔手术入路治疗下颌骨边缘型化脓性骨髓炎的临床疗效评价

Evaluation of clinical efficacy in transoral surgical approach for treating marginal type pyogenic osteomyelitis of mandible

目的探讨经口腔手术入路治疗下颌骨边缘型化脓性骨髓炎的临床疗效。方法回顾分析2014年1月至2019年6月肇庆医学高等专科学校附属医院口腔颌面外科收治的55例单侧下颌骨边缘型化脓性骨髓炎病例资料,分为口内组和口外组。口内组采用口腔内下颌支前缘外斜线切口入路清除病灶,口外组采用传统的口腔外下颌角做皮肤切口。分析两组术后临床疗效、病灶和手术切口情况、手术并发症。结果口内组临床病征的总体临床疗效优于口外组,其中轻、中、重度张口受限恢复程度明显优于口外组(P<0.05),手术切口愈合情况明显优于口外组(P<0.05)。两组锥形束CT(CBCT)复查病灶变化差异无统计学意义(P>0.05)。口外组术后出现涎瘘1例,轻度口角歪斜2例,8例皮肤切口出现不同程度软组织弹性变差、针刺感、异物感等症状,随访1年所有症状有所好转。口内组未发现上述手术并发症,1例患者术后出现同侧颞下颌关节可复性关节盘前移位,但未能证实与手术有关。结论经口腔手术入路治疗下颌骨边缘型化脓性骨髓炎,能有效清除病灶,改善张口受限,促进切口愈合,同时避免了皮肤瘢痕、面神经及腮腺损伤等并发症。

Objective To explore the clinical efficacy of transoral surgical approach for the treatment of marginal type pyogenic osteomyelitis of mandible.Methods The data in 55 cases of unilateral marginal type pyogenic osteomyelitis of mandible treated in the oral and maxillofacial surgery department of Affiliated Hospital of Zhaoqing Medical College from January 2014 to June 2019 were retrospectively analyzed.The cases were divided into the intraoral group and extraoral group.The intraoral group adopted external oblique incision approach at the anterior edge of mandibular ramus,and the extraoral group adopted the conventional extraoral mandibular angle as the skin incision.The clinical efficacy,lesions and surgical incision situation and surgical complications after operation were analyzed in the two groups.Results The overall clinical effect of clinical symptoms in the intraoral group was better than that of the extraoral group,in which the recovery situation of mild,moderate and severe mouth opening restriction was significantly better than that in the extraoral group(P<0.05),the incision healing situation was significantly better than that in the extraoral group(P<0.05).The changes of CBCT reexamination had no statistical difference between the two groups(P>0.05).The extraoral group appeared 1 case of salivary fistula after operation,2 cases of mild distortion of commissure,the skin incision in 8 cases appeared different degrees of symptoms such as soft tissue elasticity variation,acanthesthesia and foreign body sensation,all symptoms were improved after 1 year follow-up.The above operative complications were not found in the intraoral group,1 case appeared recurrent anterior disc displacement of the ipsilateral temporomandibular joint after operation,but which did not verified to be related with the operation.Conclusion The transoral operative approach for treating marginal type pyogenic osteomyelitis of mandible can effectively remove the lesions,improve the limitation of mouth opening,promote the incision healing,meanwhile avoid the complications such as skin scar and injury of facial nerve and parotid gland.