介入治疗口腔颌面肿瘤

现将我科 1992年以来的口腔颌面部肿瘤 8例行经导管选择性动脉造影和栓塞术总结如下。一、资料与方法1.一般资料 :男性 6例 ,女性 2例 ,年龄 16岁～ 5 8岁 ,其中面部蔓状动脉瘤 1例 ,颌骨中心性血管瘤 1例 ,颏部神经纤维瘤 1例 ,上颌窦恶性肿瘤 3例 ,舌根癌 2例。术前颈动脉造影 8例 ,术前辅助性栓塞 6例且同期行手术治疗 ,2例仅行栓塞术。其中 2例术后组织缺损即期整复。2 .造影检查 :8例均先行靶动脉造影。国产ＫＢ -40 0ｍＡＸ诊断机 ,拆除透视荧屏并安装日本产影像增强、电视监视系统 ;美国ＣＯＯＫ公司生产的 6 .5Ｆ管径聚乙烯导管和导…     

鼻内镜下两种手术径路治疗上颌窦囊肿80例临床分析

目的:探讨鼻内镜下两种手术径路治疗上颌窦囊肿的临床疗效。方法:通过比较35例采用上颌窦自然口径路与45例采用下鼻道开窗径路治疗上颌窦囊肿进行回顾性分析。结果:经鼻内镜下两种不同手术径路治疗,手术均获得成功,术中出血均少于50 mL,无明显手术并发症。继续随防6个月～1年,患者鼻腔通气良好,面部胀痛、头痛、头昏等临床症状消失,鼻内镜下检查见上颌窦腔光滑,无脓性分泌物,无复发。结论:鼻内镜下行上颌窦囊肿切除手术直观,创伤小,术后反应轻,根据上颌窦囊肿位置类型选择不同手术径路,效果更理想。     

上颌窦径路治疗三叉神经痛9例报告

目的:解决三叉神经痛第二支术后复发。方法:采用经上颌窦径路在翼腭窝内行上颌神经切断撕脱术治疗三叉神经痛。结果:共治疗9例,术后随访12～2 4个月,治愈率10 0 % ,无复发病例。结论:经上颌窦径路上颌神经切断术手术创伤小、效果好、避免经颅手术的并发症,是治疗复发性上颌神经痛的较好方法。     

神经干切断术治疗顽固性上颌神经痛的临床应用

目的　提高顽固性三叉神经痛 (第Ⅱ支 )的手术治疗效果 ,减少术后复发。方法　采用经口内上颌窦径路在翼腭凹内行上颌神经圆孔外口切断术治疗三叉神经痛 2 7例。结果　经口内上颌窦径路在翼腭凹圆孔外口处可高位切断上颌神经 ,术后 1周疼痛消失或缓解的有效率达 10 0 % ,2 2例经术后 1～ 5年的随访或信访 ,暂无复发病例。结论　该手术创伤小 ,视野清楚 ,术后恢复快 ,治疗效果好     

上颌窦径路上颌神经撕脱术12例临床报告

目的：探讨经上颌窦径路进行三叉神经第二支撕脱术的临床效果。方法：采用经上颌窦径路在翼腭窝内圆孔外口行上颌神经撕脱术12例，术后随访12-24月观察临床疗效。结果：12例均治愈，无再次复发病例。结论：上颌窦径路上颌神经撕脱术创伤小，是治疗上颌神经痛的较好方法。     

3种径路鼻内镜下治疗上颌窦囊肿150例疗效分析

目的：探讨3种径路鼻内镜下治疗上颌窦囊肿的疗效差异。方法：分析近年来收治的150例上颌窦囊肿病例的临床资料,依据囊肿不同位置及是否伴有其他病变,对其采取3种不同手术径路切除,即经上颌窦自然口径路切除58例,经下鼻道开窗径路切除39例,经上颌窦前壁径路切除53例,评价3种径路的治疗效果。结果：150例患者,经过6～12个月的随访,术后鼻腔通气良好,面部胀痛、头痛、头昏等临床症状消失,经鼻内镜及鼻窦CT检查,无脓性分泌物,无囊肿复发。结论：根据上颌窦囊肿位置类型及伴有的疾病不同,鼻内镜下选择不同径路手术,上颌窦囊肿的术后康复效果更理想。     

经上颌窦神经撕脱术治疗三叉神经痛Ⅱ支

目的:评价经上颌窦神经撕脱术治疗三叉神经痛Ⅱ支的疗效。方法:选择1994-08—2009-05期间我科收治的60例经上颌窦神经撕脱术治疗三叉神经痛Ⅱ支的患者进行疗效观察。结果:60例患者手术后均无疼痛,随访1～3年,术后2年疼痛复发6例,术后3年疼痛复发4例,复发率为16.67%。但复发后疼痛均较术前明显减轻,患者能够忍受。所有患者术后除患支区皮肤和黏膜有麻木感外均无其他并发症,麻木感在0.6～1年后逐渐减轻。结论:经上颌窦神经撕脱术治疗三叉神经痛Ⅱ支,效果较好,复发率低,并发症少,是安全有效的治疗方法。     

介入治疗在下颌骨动静脉畸形的临床应用

目的:总结下颌骨动静脉畸形的诊断与综合治疗经验。方法:回顾性分析本科1998-2004年临床资料完整的下颌骨动静脉畸形5例。患者均经过数字减影血管造影和术前超选择性动脉栓塞治疗,采用的栓塞材料主要为明胶海绵、聚乙烯醇泡沫、附凝血棉纤毛的弹簧圈。1周内手术:2例行下颌骨部分切除术,3例行颌骨病灶搔刮术+自体髂骨松质骨植入术。结果:5例患者经综合治疗后随访1～5年,植骨患者随访X线片显示植骨区有新骨形成。结论:下颌骨动静脉畸形的X线表现不典型,数字减影血管造影具有特异性诊断价值。治疗应采取综合治疗模式。     

颌面深部血管性疾病的诊断与综合治疗

目的 研究颌面部血管性疾病的影像学诊断与治疗的临床意义。方法 对1988年8月至2000年7月的12年间在我院就诊的12例颌面深部血管性疾病的放射学检查及治疗效果进行评价。结果 12例均行DSA造影检查。7例经血管造影明确诊断后，即经导管作超选择性颈外动脉分支的栓塞治疗，其中3例血管畸形的患者经永久性栓塞治疗治愈，随诊3年无复发；2例经永久性栓塞治疗后均于1年内复发，经再次栓塞及手术，病理证实为蔓状血管瘤；另2例经栓塞治疗后1周内行手术治疗，病理诊断亦为蔓状血管瘤。其余5例造影后行手术治疗，病理诊断除1例为海绵伏血管瘤外，均为毛细血管瘤。结论 血管造影是颌面深部血管性病变的重要诊断手段；手术是颌面深部血管性疾病主要的治疗措施；颌面深部血管性疾病的完善治疗有赖于多种治疗方法的完美结合。     

选择性血管栓塞术辅助颈动脉体瘤切除术

目的观察颈动脉造影及选择性血管栓塞术对颈动脉体瘤切除术的影响。方法选择7例颈动脉体瘤患者为研究对象,其中4例于手术前行颈动脉造影及选择性血管栓塞术,其余3例不行血管栓塞术。7例患者均行手术治疗,均采取剥离肿瘤与颈动脉的术式,比较术前行选择性血管栓塞与否的治疗效果。结果7例患者的颈动脉体瘤均为Shamblin Ⅲ型,CT以及三维重建影像能清楚显示肿瘤及其与周围动脉的关系。所有病例均完整切除肿瘤而未结扎颈内、颈外动脉,术后均无严重并发症发生。4例术前行选择性血管栓塞术的患者术中出血量平均为160 mL,手术时间平均为2.5 h;3例未行血管栓塞术患者的术中出血量平均为600 mL,手术时间平均为4 h。术后随访1.5～3年,7例患者均无复发。结论颈动脉体瘤术前行颈动脉造影和选择性血管栓塞术可以有效减少术中出血,有助于降低手术的风险。     

Endoscopic surgical treatment of chronic maxillary sinusitis of dental origin.

PURPOSE: Chronic maxillary sinusitis of dental origin (CMSDO) is a common disease that requires treatment of the sinusitis as well as of the odontogenic source. We present our surgical experience performing contemporary treatment of the odontogenic source and endoscopic sinus surgery (ESS) in patients with CMSDO. PATIENTS AND METHODS: Seventeen patients with CMSDO underwent contemporary treatment of the odontogenic source and ESS. Five patients presented chronic oroantral fistula (OAF); 5 patients presented odontogenic cysts occupying the maxillary sinus; 2 patients had inflammatory cysts of the molars; 2 patients had maxillary sinus infection secondary to peri-implantitis; 3 patients had foreign bodies pushed through the root canal into the sinus. The first surgical step was the treatment of the odontogenic source. The second step was ESS with opening and calibration of the maxillary natural ostium. RESULTS: Foreign bodies were extracted from the sinuses through the endonasal approach. No major complications after ESS were observed. The average time for ESS was +/-25 minutes. Good distant results without symptoms and complete closure of the fistula were obtained in all patients. CONCLUSION: When significant sinus disease is found, an endoscopic approach to drainage in all of the involved sinuses can promote predictably successful closure of OAF. The endoscopic approach to chronic maxillary sinusitis of dental origin is a reliable method associated with less morbidity and lower incidence of complications.     

上颌骨Le Fort I型截骨进路切除巨大鼻咽纤维血管瘤

目的:探讨上颌骨LeFortI型截骨进路切除累及翼腭凹、颞下凹巨大鼻咽纤维血管肿瘤的可行性。方法:采用矫正上颌骨先天或后天畸形的LeFortI型截骨术式进路,切除位于鼻咽部、筛窦等深在部位的纤维血管瘤。结果:该进路术野显露充分,取得了理想的治疗效果。结论:上颌骨LeFortI型截骨进路是切除鼻咽、颅底部纤维血管瘤的理想进路。     

Surgical approaches for nasopharyngeal angiofibroma: comparative analysis and current trends

This study presents a comparative analysis of current surgical approaches for the treatment of nasopharyngeal angiofibroma, including extension of tumors, postoperative morbidity, complications, and recurrence rate. Twenty-four patients who underwent surgery with the diagnosis of juvenile nasopharyngeal angiofibroma at our department between 1993 and 2003 were retrospectively reviewed according to their clinical presentation, surgical approaches, and prognosis. Radkowski staging scale was used for staging tumors. The transpalatal approach was used in 10 patients before 1999 with tumor stages between Ia and IIa. Transpalatal fistula was encountered in one. Nine patients underwent transnasal endoscopic surgery after 1999 with tumor stages between Ia and IIIa. Lateral rhinotomy in four patients and a degloving approach in one patient were used with tumor stages between IIa and IIIa; postoperative nasal crusting was the most annoying problem in these groups. Recurrent tumor was seen in only one patient who had undergone the transpalatal approach in the 12- to 56-month follow-up period. In this regard, the transnasal endoscopic approach can be used successfully in place of the transpalatal approach due to the former's lesser surgical morbidity and wide lateral exposure of the field in patients with nasopharyngeal angiofibroma. Also, many patients who underwent lateral rhinotomy for the removal of stage IIa, IIb, and IIIa tumors can successfully be treated using the transnasal endoscopic approach. In tumors that extend, infratemporal fossa lateral rhinotomy and degloving approaches provide the optimal exposure but have higher potential for morbidity than does transnasal endoscopic surgery.     

内窥镜在牙拔除术断根误入上颌窦诊治中的研究

目的研究断根误入上颌窦后利用牙槽窝通路,使用内窥镜诊断及取断根的方法。方法对在拔牙过程中怀疑牙根断入上颌窦的13例病例,使用内窥镜进行诊断,对于明确断根完全进入上颌窦的病例行经牙槽窝直视下取出断根,同时行牙龈黏膜减张严密缝合。对于断根未进入上颌窦的行保守治疗。结果 13例患者中有7例为完全进入上颌窦,采用内窥镜从牙槽窝进入,均成功取出断根。13例病例术后1月黏膜愈合良好,均未出现口腔上颌窦瘘。术后3月除1例患者失访,其余牙槽窝愈合良好。结论利用内窥镜扩大视野可准确判断牙根是否完全进入上颌窦。采用经牙槽窝扩大内窥镜取根法可以在直视下取出进入上颌窦的断根,创伤小,术后恢复良好,是一种微创、快捷的方法。     

Evaluation of maxillary sinus after treatment of midfacial fractures.

PURPOSE: Maxillary sinuses are the most frequently injured anatomic region of the facial skeleton in midfacial fractures. The purpose of this study was to evaluate the patients with maxillary sinus wall fractures using clinical examinations, maxillofacial computed tomography (CT), and cranial bone single-photon emission tomography (SPECT) and to interpret the results of these examinations to evaluate the indications of surgical intervention or drainage for maxillary sinus after maxillary sinus wall fractures. MATERIALS AND METHODS: The results of examinations of 15 patients with maxillary sinus fractures who were treated for midfacial fractures were evaluated. Follow-up examinations were performed in the range of 3 to 47 months after surgery (average, 19.8 months). The patients ranged in age from 10 to 45 years, with an average age of 31.6 years. There were 11 male and 4 female patients. Seven patients had Le Fort II fractures, 6 patients had tripod zygomatic fractures, 1 patient had infraorbital fracture, and 1 patient had zygomatic arch fracture. Operative procedure was performed in all cases. To evaluate maxillary sinus after surgery, maxillofacial computed tomography (CT), cranial bone SPECT, and maxillary sinusitis evaluation form were used in all patients. RESULTS: Maxillofacial CT scans were related to sinusitis in 9 patients who had positive complaints for sinusitis. The cranial bone SPECT showed positive uptake at the fractured sites in 8 patients, minimal uptake in 2 patients, and normal uptake in 5 patients. CONCLUSIONS: Clinical examination, maxillofacial CT, and cranial bone SPECT are the most reliable methods available today for the diagnosis and follow-up of complications of maxillary sinus fractures.     

Usefulness of CT images for diagnosis of odontogenic maxillary sinusitis

To assess the usefulness of CT images for the diagnosis of suspected odontogenic maxillary sinusitis, 52 patients with maxillary sinusitis who had received CT examination were retrospectively analyzed. maxillary sinus ostium was established on coronal CT image in 20 out of 55 lesions in those 52 patients. However, a considerable number of patients who had inflammatory disease not only in the maxillary sinus but also in other paranasal sinuses (38/55) or in the nasal meatus (34/55) were included in those 52 patients. Concerning the opening of the ostium, the clinical diagnosis is frequently different from the diagnosis made using CT. The CT findings of the maxillary sinus ostium, nasal meatus and other paranasal sinuses were thus important in planning the treatment for patients with maxillary sinusitis in dentistry, as in otorhinolaryngology.     

Juvenile angiofibroma of the maxillary sinus. A case report.

The clinicopathological features of a rare case of juvenile angiofibroma originating from the maxillary sinus of a 13-year-old boy are reported. This tumor was composed of angiomatous and fibrous structures. The analysis of nucleolar organizer regions (NOR) of the various components of this tumor indicated that the fundamental elements were the fibroblastic cells, rather than the vascular endothelial cells.     

Clinicopathologic features of dentigerous cysts in the maxillary sinus

Dentigerous cyst (DC) in the maxillary sinus is extremely rare. This study evaluated the clinical features, etiologic factors, imaging, treatment, and signs and symptoms of this type of DC. Clinical symptoms, radiographic findings, surgical methods, and histopathologic findings of 4 patients with DCs in the maxillary sinus were evaluated. In addition, we reviewed the literature reports of DCs in the maxillary sinus over the past 40 years. Our 4 patients with DC in the maxillary sinus showed the following results: (1) all the patients were males at first 3 decades of age, (2) swelling and/or yellow-green pus discharges from pharyngeal cavity were common symptoms, (3) the involved teeth in the DC were the maxillary third molar teeth and supernumerary teeth, and (4) Caldwell-Luc approach was performed in these 4 patients. The patients with DC in the maxillary sinus should be evaluated thoroughly by extraoral and intraoral examinations, proper diagnostic imaging procedures, and pathologic examination to avoid misdiagnosis of maxillary sinusitis. The standard treatment for DC in the maxillary sinus is often removed by Caldwell-Luc approach. Furthermore, marsupialization or functional endoscopic sinus surgery may be performed because of the size, location of the cysts, or the age of the patients.     

Maxillary sinus augmentation: histologic and histomorphometric analysis

PURPOSE: Implant placement in the posterior maxilla may often be contraindicated because of insufficient bone volume and the presence of the maxillary sinus. In these situations, sinus floor lifting and grafting frequently have been proposed as the best treatment. The aim of this study was to compare histologically the use of 100% autogenous bone versus a combination of autogenous bone and corticocancellous pig bone for maxillary sinus augmentation. MATERIALS AND METHODS: Eighteen patients requiring bilateral maxillary sinus augmentation were selected for this study. Bone for grafting was harvested from the iliac crest. Each patient received 100% autogenous bone in 1 randomly selected sinus (control side) and a 1:1 mixture of autogenous bone and corticocancellous pig bone particles in the contralateral sinus (test side). Five months after the augmentation procedure, bone biopsy specimens were taken at the time of implant placement. RESULTS: No complications were observed during the surgical procedures; all patients healed uneventfully. No signs or symptoms of maxillary sinus disease were observed during the 5 months after surgery. No significant differences in bone percentages were observed in the bone biopsies from test and control sides. DISCUSSION AND CONCLUSION: It could be concluded from this study that corticocancellous pig bone particles can be successfully used in a 1:1 mixture with autogenous bone from the iliac crest for maxillary sinus augmentation in cases of severely atrophic maxilla.     

Nasopharyngeal angiofibroma. surgical approach using a transoral Le Fort I osteotomy following embolization: a case report

Nasopharyngeal angiofibroma (NA) is a rare vascular benign nonencapsulated neoplasm, characterized by local aggressiveness and destructive potential, typically diagnosed in adolescent males. We report a case of NA affecting a 15-year-old male that presented with a persistent nasal obstruction and epistaxis with 1 year of evolution. Clinical and radiological patterns pointed out a differential diagnosis of NA. Arteriography demonstrates the vascular support of the tumor and evinces the embolization of the internal maxillary artery. The surgical approach was procedure by Le Fort I osteotomy exposing the tumor and promoting easy access for posterior removal. The surgery was carried out without hemorrhagic problems. The maxilla was fixed in the original position with 4 L-shape plaques. Histopathological findings supported the diagnosis of NA. The patient presented after 8 months of postoperative follow-up, without clinical signs of recurrence or residual tumor and without palatal or maxillary teeth paresthesia.