牙源性鼻旁瘘管.DOCVIP

临床医学论文-牙源性鼻旁瘘管 【摘要】? 目的 探讨上颌尖牙根尖炎并发鼻旁瘘管的诊断和治疗方法。方法 对6例上颌尖牙根尖炎并发鼻旁瘘管进行回顾分析。6例患者行鼻部CT或X线拍片检查未见明显异常，4例误诊为上颌骨骨髓炎、皮脂腺囊肿感染和基底细胞癌等；2例行牙X线摄片检查确诊为牙源性鼻旁瘘管；手术治疗采用局部切除缝合、拔除病源牙、搔刮根尖创面，清除病灶。结果 6例患者面部切口全部I期愈合，经过2 10年追踪观察，瘘管未再复发。结论 鼻旁瘘管应首先考虑牙源性疾病所致，进行口腔科检查有助于减少误诊。 【关键词】? 瘘管 牙根 鼻 诊断 外科手术 ????? Abstract: Objective? To explore the diagnosis and treatment of apicitis of the maxillary canine complicated with paranasal fistula. Methods? The clinical data of 6 patients with apicitis of the eye tooth complicated with paranasal fistula were retrospectively analysed. No abnormality was found in the nasal CT or Xray images. 4 patients were misdiagnosed as osteomyelitis of the maxilla， infectionus ofsebaceous cyst or basal cell carcinoma. 2 patients underwent dental filming and were finally diagnosed as paranasal fistula. In the? operations, all were locally ectomized and sutured, the diseased teeth were pulled out, and the raw surfaces of the root tip were scoraped to clean the focus of infection. Results? The prospocut of all? 6 cases ended up with primary healing, and after 2 to 10 years followup,? no recurrence was found. Conclusions? Paranasal fistula may be caused by odongenic diseases and so stomatological examination is necessary for minimizing the misdiagnosis rate.? ??? Key words: Fistula; Tooth root; Nose; Diagnosis; Surgical procedures, operative??? 牙源性鼻旁瘘管源于上颌前牙化脓性根尖周炎，患者多为老年人，临床较少见，易被误诊、误治。青岛大学医学院附属烟台毓璜顶医院1990年2月至2005年3月收治6例上颌尖牙根尖炎并发鼻旁瘘管患者，现报道如下。 ??? 1? 资料与方法 ??? 1.1? 一般资料? 6例患者中，男4例，女2例；50 75岁，平均67.5岁；左尖牙3例，右尖牙3例；鼻旁瘘管时间最短1个月，最长5年；初次就诊情况：4例行鼻部CT或拍片检查未见明显异常，误诊为上颌骨骨髓炎、皮脂腺囊肿感染及基底细胞癌等，2例行牙X线摄片检查确诊为牙源性鼻旁瘘管。 ??? 1.2? 典型病例? 男，64岁，因左侧鼻旁肿胀8个月、流脓6个月入院。患者于8个月前无明显诱因出现左侧鼻旁肿胀，无疼痛，无视物障碍，无鼻塞，曾在当地诊断为“上颌骨骨髓炎”并进行抗感染治疗，症状无好转。于6个月前用中药外敷后破溃出现持续性脓性分泌物，在当地行鼻窦CT扫描未见明显异常，继续抗感染治疗仍无好转。在我院门诊行牙X线摄片检查后以“牙源性鼻旁瘘管”收入院。查体：左侧鼻旁见一直径约2?mm的小孔，有脓性分泌物，其周围轻度肿胀，探针检查瘘管通向左侧上尖牙。鼻腔检查未见异常。患者上颌牙大多数已脱落，存留部分残根，尖牙无松动。牙X线摄片检查见左侧尖牙残根处有透光区，确诊为牙源性鼻旁瘘管。 ??? 1.3? 治疗方法? 6例患者确诊后行鼻旁瘘管切除术，术中于瘘管口周围作一梭形切口，沿瘘管周围分离，见瘘管通向左侧上尖牙，拔除尖牙，刮匙刮除根尖部肉芽