上顎骨巨大囊腫的保守性療法

Conservative Treatment for Extensive Maxillary Cysts

吳禕凡(Yi-Fan Wu) ； 張加明(Chia-Ming Chang) ； 高主強(Chu-Chiang Kao) ； 陳遠謙(Michael Yuan-Chien Chen)

《臺灣口腔顎面外科學會雜誌》 20卷4期 (2009/12) Pp. 235-243

https://doi.org/10.7104/TJOMS.200912.0235

摘要

本篇報告旨在統計自2004年至2008年間，因上顎骨巨大囊腫至台中市中國醫藥大學附設醫院口腔顎面外科接受治療的患者，其中接受保守性減壓術治療的患者共十五例，主要針對其治療效果及治療過程中可能造成的併發症及相關的處置方式進行探討。曾有文獻針對下顎骨發生的巨大囊腫以減壓爲首要治療方式的治療結果進行統計分析，但上顎骨巨大囊腫在治療上因解剖構造的特異性（如：上顎竇）而與下顎骨有不同的考量。因此，本篇報告以減壓術做爲此十五例患者的首要治療方式，平均減壓時間爲319.2天，其中有十一例患者在經過減壓治療一段時間後接受徹底的囊腫剜除手術，此十一例患者在囊腫剜除術後平均追蹤時間爲415.7天，其間皆未發現病灶復發的情形。此種減壓治療方式的主要優點在於對患的侵入性小，通常在局部麻醉下即可進行，在取得病理切片的同次療程置入減壓裝置，對鄰近重大解剖構造的破壞性相對較小，減壓後的追蹤電腦斷層影像皆顯示囊腫體積有顯著的縮小。因此，我們建議上顎骨的巨大囊腫以此種減壓術做爲首要的治療方式。

關鍵字

上顎骨巨大囊腫 ； 減壓術

並列摘要

This retrospective study was conducted to evaluate the benefits and effectiveness of conservative decompression as the primary treatment modality for extensive maxillary cysts, regardless of the histological classification. Fifteen patients with huge maxillary cysts of more than 30 mm in greatest dimension with extensive involvement of either nasal cavity or maxillary sinuses treated at our department were enrolled in this clinical study. An individualized computed tomography (CT) scan, taken parallel to the occlusal plane, was arranged for each patient before and after the decompression procedure. All the axial CT images were made parallel to the patient's mandibular occlusal plane, while the coronal CT images were obtained perpendicular to the mandibular occlusal plane. The greatest antero-posterior, transverse and vertical dimensions of all the cystic lesions in their pre and post-decompression status were calculated by a computerized software. After a mean decompression period of 319.2 days, the average volume shrinkage of the maxillary bony defects was 41% in antero-posterior dimension; 40% in transverse dimension and 39% in vertical dimension. When the cystic lesions were completely enucleated, there was no sign of recurrence after an average follow up period of more than one year.
Although decompression may be time consuming, the minimally invasive procedure for large maxillary cysts should be highly recommended due to its advantages of reduced risk of oro-antral or oro-nasal communication, maxillary sinusitis and recurrence.

並列關鍵字

extensive maxillary cyst ； decompression