经鼻内镜手术治疗的牙源性鼻窦炎患者临床特征分析

Clinical characteristics of patients with odontogenic sinusitis underwent endoscopic sinus surgery

目的分析经内镜鼻窦手术(ESS)治疗的牙源性鼻窦炎(odontogenic sinusitis,OS)患者的临床特征。方法回顾性分析2018年1月至2020年11月于北京朝阳医院耳鼻咽喉头颈外科行ESS治疗的27例OS患者的临床特征,其中男性16例,女性11例,年龄(49.74±14.42)岁(x±s),分析内容包括病史、症状、鼻内镜检查及鼻窦CT表现。采用SPSS 19.0软件进行统计学分析。结果OS以单侧为主,病程(8.56±11.79)个月,70.4%(19/27)的患者病程在6个月内,超过12个月者只有11.1%(3/27)。症状以鼻塞(88.9%;24/27)、流涕(81.5%;22/27)、鼻腔自觉腥臭味(16/19)及鼻后滴漏(10/10)最为常见。63.0%(17/27)的患者有牙病史。鼻内镜检查77.8%(21/27)可见窦口鼻道复合体肿胀,55.6%(15/27)可见上颌窦内侧壁内移,70.4%(19/27)可见中鼻道内白色乳液样脓性分泌物,59.3%(16/27)可见中鼻道息肉形成。OS的病因包括种植牙相关问题(14.8%;4/27)以及根尖周病(85.2%;23/27)。结论OS通常是病史较短的单侧鼻窦炎。患者自觉鼻腔腥臭味、内镜下可见白色稀薄脓液、影像学显示以单侧上颌窦为主的炎症合并牙齿相关病变为其主要特征。

Objective To analyze the clinical features of patients with odontogenic sinusitis(OS)treated by endoscopic sinus surgery(ESS).Methods A retrospective investigation was carried out in our 27(16 males and 11 females)cases with OS aged(49.74±14.42)years old.Subjects were hospitalized between January 2018 and November 2020 from Department of Otorhinolaryngology Head and Neck Surgery,Beijing Chaoyang Hospital.The medical history,symptoms,result of nasal endoscopy and paranasal sinus computed tomography(CT)were analyzed statistically by SPSS 19.0.Results OS mainly occured on unilateral sinuses,with a duration of(8.56±11.79)months.Seventy point four percent(19/27)of the patients had a course within six-month,only 11%was over 12 months(3/27).Symptoms mostly showed as nasal obstruction(88.9%;24/27),runny nose(81.5%;22/27),nasal stinks(16/19)and postnasal drip(10/10).Sixty-three percent(17/27)of the OS patients had a dental history.Nasal endoscopic examination revealed a swelling of the ostiomeatal complex(77.8%;21/27),medial wall interhal displacement of maxillary sinus(55.6%;15/27),white emulsion-like purulent secretion in the middle meatus(70.4%;19/27)and nasal polyps(59.3%;16/27).Etiology of OS included implant-related problems(14.8%;4/27)and periodontal disease(85.2%;23/27).Conclusions OS is usually unilateral sinusitis with a short history.Its clinical features show nasal stinks,white emulsion-like purulent secretion in the middle meatus and imaging findings of unilateral maxillary sinusitis with tooth-related lesions.