齒源性囊腫引發上頜竇鼻竇炎之治療

Surgical Management of Odontogenic Cyst Related Maxillary Sinusitis

許弘義(Hung-I Hsu) ； 藍敏瑛(Ming-Ying Lan) ； 何青吟(Ching-Yin Ho)

《台灣耳鼻喉頭頸外科雜誌》 51卷1期 (2016/03) Pp. 21-27

https://doi.org/10.6286/2016.51.1.21

摘要

背景：齒源性囊腫為少見之牙科病灶，其盛行率約為3.5%~12.8%。齒源性囊腫常合併齒源性上頜竇鼻竇炎。齒源性囊腫引發之上頜竇鼻竇炎，外科處置方式上除了應以口腔外科手術移除牙科病灶以外，功能性鼻竇內視鏡手術也扮演重要角色。本研究針對齒源性囊腫引發之上頜竇鼻竇炎的症狀、特徵、診斷及治療結果加以分析。方法：回溯性收集2002至2013年間，共88例在本院經診斷並接受治療的齒源性上頜竇鼻竇炎患者，其中12例導因於齒源性囊腫，分析病患特徵、診斷、病理診斷、治療及預後。結果：12名病患，7名男性，5名女性，年齡分佈17至64歲，平均年齡37.7歲，症狀以牙齦腫痛、鼻塞為主，其餘為鼻異味、鼻涕及臉頰疼痛，且症狀皆為單側鼻竇或牙齦症狀。所有病患均於術前安排鼻竇內視鏡檢查、環口攝影檢查(panoramic radiography)影像檢查及電腦斷層檢查，並接受牙科手術或牙科手術合併鼻竇內視鏡手術治療。手術前後，病患主訴症狀皆有所改善。結論：齒源性鼻竇炎為單側性鼻竇炎的重要鑑別診斷。而齒源性囊腫為齒源性鼻竇炎的重要成因之一。懷疑齒源性囊腫的病患皆應接受完整的口腔及鼻腔檢查，及影像學檢查。口腔外科手術合併鼻竇內視鏡手術可以有效治療齒源性囊腫引發之上頜竇鼻竇炎。

關鍵字

鼻竇內視鏡手術 ； 牙痛 ； 齒源性囊腫 ； 齒源性鼻竇炎

並列摘要

BACKGROUND: Odontogenic cyst is a rare dental condition, with a prevalence of 3.5%~12.8%. Odontogenic cyst commonly results in odontogenic maxillary sinusitis. Historically, the surgical management of odontogenic cyst related odontogenic maxillary sinusitis is dentally-directed. However, functional endoscopic sinus surgery plays an important role in treating this group of patient. This study aims to investigate the symptoms, diagnosis and treatment outcomes of odontogenic cyst related odontogenic maxillary sinusitis. METHODS: A retrospective chart analysis was completed on eighty-eight patients with odontogenic maxillary sinusitis from July, 2002 to September, 2013. These patients were all treated at Taipei Veteran General Hospital. Twelve patients were diagnosed with odontogenic cyst as their disease origin. Patients' age, gender, symptoms, underlying medical disease, diagnosis, pathologic report, and treatment were analyzed. The postoperative outcome was evaluated by hospital stay, duration of antibiotics treatment and the improvement of symptoms, which includes facial pain, toothache, rhinorrhea, nasal obstruction and nasal odor. RESULTS: A total of 12 cases diagnosed with odontogenic cyst were included. There were 7 male and 5 female patients, with a mean age of 37.7 years (age distribution 17-64years). These patients all presented with single-sided nasal or dental symptoms. All patients received sinoscopy, panoramic radiography and computed tomography preoperatively. Surgical management includes dental procedures alone or dental procedure combined with functional endoscopic sinus surgery (FESS). All patients showed improvement of all five common symptoms of odontogenic maxillary sinusitis. CONCLUSIONS: Odontogenic maxillary sinusitis is an important differential diagnosis of single-sided rhinosinusitis. Odontogenic cyst, although rare in disease prevalence, is important in concerning the etiology of odontogenic maxillary sinusitis. All patients concerned with odontogenic cyst should receive thorough examination of the oral and nasal cavity along with radiographic exam. Dental procedure combined with functional endoscopic sinus surgery showed excellent outcomes in treating odontogenic cyst related odontogenic maxillary sinusitis.

並列關鍵字

endoscopic sinus surgery ； toothache ； odontogenic cyst ； odontogenic sinusitis