以牙痛为主诉的霉菌性上颌窦炎的CBCT影像学表现及误诊分析

CBCT imaging and misdiagnosis of mycotic maxillary sinusitis with toothache as the main complaint

目的探讨以牙痛为主诉的霉菌性上颌窦炎的口腔颌面锥形束CT(cone beam computed tomography,CBCT)影像学特征及误诊原因。方法回顾性分析经病理证实的9例以牙痛为主诉的霉菌性上颌窦炎的CBCT影像学表现,分析误诊原因。结果 9例病变均发生在单侧上颌窦(左侧6例,右侧3例),病变上颌窦内密度增高,见不均匀软组织影充满窦腔,内见斑片、团块或条行钙化,窦腔无扩大征象,上颌窦外、后壁骨质有不同程度的增生。其中2例上颌窦软组织影侵入同侧中鼻道和前组筛窦。6例误诊为牙髓炎,3例误诊为三叉神经痛。结论以牙痛为主诉的霉菌性上颌窦炎容易误诊为口腔疾病,CBCT对霉菌性上颌窦炎窦腔软组织内的钙化具有特异性,有较高的诊断价值。

Objective To investigate the CBCT imaging characteristics and misdiagnosis of mycotic maxillary sinusitis with toothache as the main complaint.Methods The CBCT findings of 9 cases of pathologically confirmed fungal maxillary sinusitis with toothache as the main complaint were analyzed retrospectively.The causes of misdiagnosis were analyzed.Results All the 9 lesions occurred in unilateral maxillary sinus.The density in the lesioned maxillary sinus increased.The sinus cavity was filled with inhomogeneous soft-tissue shadows,in which plaque,mass or strip calcification were found,without sign of enlargement.The bone of the outer and posterior wall of the maxillary sinus showed hyperplasia at different degrees.Among them,2 cases presented soft-tissue shadows of the maxillary sinus invading the ipsilateral middle meatus and anterior ethmoid sinus.Six cases were misdiagnosed as pulpitis and 3 as trigeminal neuralgia.Conclusions Fungal maxillary sinusitis with toothache as the main complaint is easily misdiagnosed as oral disease.CBCT is specific for calcification in the soft tissue of the sinus cavity in fungal maxillary sinusitis and has high diagnostic value.