CBCT评价开窗减压术治疗青少年颌骨囊肿的临床疗效
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摘要
目的观察开窗减压术前术后颌骨囊腔体积的变化、受累牙牙髓活力的变化、下颌神经管形态的恢复和囊腔相关受累牙胚的发育情况,从而评价青少年颌骨囊肿开窗减压术的治疗效果。方法观察30例青少年颌骨囊肿开窗减压术前及术后不同时期的CBCT影像学资料,测量囊腔体积,分析囊腔体积的改变与患者性别、发病部位及病理类型之间的关系。分析下颌受累牙牙髓活力恢复与下颌神经管的恢复之间的关系以及囊腔相关牙胚在开窗减压术前、术后的发育情况。结果开窗减压术后第6个月时青少年颌骨囊肿体积缩小明显。性别、发病部位和病理类型对囊腔体积变化无明显影响。下颌受累牙的牙髓活力的恢复与下牙槽神经管的恢复有关。术后保留的囊腔内牙胚均可正常发育,且均有沿正常方向萌出的倾向。结论开窗减压术治疗青少年颌骨囊肿具有良好的效果,CBCT在评价开窗减压术治疗青少年颌骨囊肿的效果中具有较高的临床应用价值。
Objective To observe the changes of juvenile jaw bone cyst volume,the changes of pulp vitality of affected teeth,the recovery of mandibular neural tube and the development of cystic involved tooth germ before and after decompression,so as to evaluate the therapeutic effect of decompression for maxillary cyst.Methods CBCT imaging data of 30 juvenile with jaw bone cyst before and after decompression was selected to measure the cyst volume and analyzed the relationship between the change of cyst volume and patient's gender,pathologic location and pathological type. The relationship between the restoration of pulp vitality and the restoration of mandibular nerve was analyzed,as well as the development of the affected tooth germ before and after decompression. Results The size of the jaw bone cyst decreased significantly at the 6 th month after decompression.Gender,pathogenesis and pathological type had no significant effect on the change of cyst volume.The restoration of pulp vitality of mandibular affected teeth was related to the restoration of inferior alveolar neural tube. All of the dental embryos retained in the cyst cavity after decompression can develop normally,and all have the tendency to sprout in the normal direction.Conclusions Decompression has a good effect on the treatment of juvenile jaw bone cyst.CBCT is of high clinical value in evaluating the effect of decompression in the treatment of juvenile jaw bone cyst.
Objective To observe the changes of juvenile jaw bone cyst volume,the changes of pulp vitality of affected teeth,the recovery of mandibular neural tube and the development of cystic involved tooth germ before and after decompression,so as to evaluate the therapeutic effect of decompression for maxillary cyst.Methods CBCT imaging data of 30 juvenile with jaw bone cyst before and after decompression was selected to measure the cyst volume and analyzed the relationship between the change of cyst volume and patient's gender,pathologic location and pathological type. The relationship between the restoration of pulp vitality and the restoration of mandibular nerve was analyzed,as well as the development of the affected tooth germ before and after decompression. Results The size of the jaw bone cyst decreased significantly at the 6 th month after decompression.Gender,pathogenesis and pathological type had no significant effect on the change of cyst volume.The restoration of pulp vitality of mandibular affected teeth was related to the restoration of inferior alveolar neural tube. All of the dental embryos retained in the cyst cavity after decompression can develop normally,and all have the tendency to sprout in the normal direction.Conclusions Decompression has a good effect on the treatment of juvenile jaw bone cyst.CBCT is of high clinical value in evaluating the effect of decompression in the treatment of juvenile jaw bone cyst.
引文
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[9]徐文华,程继光,王元银,等.青少年颌骨囊肿开窗减压术的疗效观察[J].安徽医药,2014,18(9):1660-1663.
[10]廖锐,孙苗根,顾亚军,等.锥形束CT在颌骨囊肿诊治中的临床应用[J].华西口腔医学杂志,2012,30(3):262-266.
[11]Asutay F,Atalay Y,Turamanlar O,et al.The three-dimensional volumetric assessment of the effect of decompression on large mandibular odontogenic cystic lesions[J].J Oral Maxillofac Surg,2016,74(6):1159-1166.
[12]田海英,施生根,刘东旭.口腔锥形束CT的安全性研究综述[J].口腔颌面修复学杂志,2014,15(1):51-55.
[13]Bodner L,Woldenberg Y,BarZiv J.Radiographic features of large cystic lesions of the jaws in children[J].Pediatr Radiol,2003,33:3-6.
[14]Liang YJ,He WJ,Zheng PB,et al.Inferior alveolar nerve function recovers after decompression of large mandibular cystic lesions[J]Oral Dis,2015,21,674-678.
[15]Ylikontiola L,Kinnunen J,Oikarinen K.Comparison of different tests assessing neurosensory disturbances after bilateral sagittal split osteotomy[J].Int J Oral Maxillofac Surg,1998,27:417-421.
[2]黄志权,张大明.微创外科技术在口腔颌面外科中的应用[J].口腔疾病防治,2018,26(2):75-82.
[3]曹裕中,邱成端,廖涛,等.12例替牙期大型颌骨囊性病变开窗减压治疗的疗效评价[J].中国口腔颌面外科杂志,2015,13(4):373-376.
[4]杨东昆,张凯,高廷益,等.Ⅰ期开窗减压、Ⅱ期刮治术在下颌骨大型囊肿治疗中的应用[J].中华解剖与临床杂志,2016,21(5):465-468.
[5]Nakamura N,Mitsuyasu T,Mitsuyasu Y,et al.Marsupialization for odontogenic keratocysts:long-term follow-up analysis of the effects and changes in growth characteristics[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2002,94:543-553.
[6]李丽洁,格根塔娜,鄂丽华.牙髓活力电测法在颌骨囊肿受累牙排查中的临床应用[J].疾病监测与控制,2015,9(11):782-783.
[7]周健,杜若鸿.颌骨囊肿的治疗方法及其临床应用[J].口腔颌面外科杂志,2012,22(4):229-232.
[8]于国霞,杜辉,王新刚,等.31例儿童及青少年期含牙囊肿保守治疗临床观察[J].北京口腔医学,2014,22(4):218-221.
[9]徐文华,程继光,王元银,等.青少年颌骨囊肿开窗减压术的疗效观察[J].安徽医药,2014,18(9):1660-1663.
[10]廖锐,孙苗根,顾亚军,等.锥形束CT在颌骨囊肿诊治中的临床应用[J].华西口腔医学杂志,2012,30(3):262-266.
[11]Asutay F,Atalay Y,Turamanlar O,et al.The three-dimensional volumetric assessment of the effect of decompression on large mandibular odontogenic cystic lesions[J].J Oral Maxillofac Surg,2016,74(6):1159-1166.
[12]田海英,施生根,刘东旭.口腔锥形束CT的安全性研究综述[J].口腔颌面修复学杂志,2014,15(1):51-55.
[13]Bodner L,Woldenberg Y,BarZiv J.Radiographic features of large cystic lesions of the jaws in children[J].Pediatr Radiol,2003,33:3-6.
[14]Liang YJ,He WJ,Zheng PB,et al.Inferior alveolar nerve function recovers after decompression of large mandibular cystic lesions[J]Oral Dis,2015,21,674-678.
[15]Ylikontiola L,Kinnunen J,Oikarinen K.Comparison of different tests assessing neurosensory disturbances after bilateral sagittal split osteotomy[J].Int J Oral Maxillofac Surg,1998,27:417-421.