以壓克力腭板輔助治療上顎正中門齒根尖囊腫合併硬脾黏膜巨大瘻管－病例報告

An Acrylic Resin Palatal Plate for Supplementary Treatment of a Radicular Cyst of the Left Upper Central Incisor with a Huge Sinus Tract at the Anterior Hard palate-case Report

莊孟哲(Meng-Che Chuang) ； 張雅琪(Ya-Chi Chang) ； 柯文昌(Wen-Chang Ko) ； 黎達明(Tat-Ming Lai) ； 黃智嘉(Chi-Chia Huang)

《中華牙醫學雜誌（中文版）》 26卷2期 (2007/12) Pp. 234-240

https://doi.org/10.7106/CJD.200712.0234

摘要

上顎前牙根尖一般多向遠心顎侧方向彎曲，一旦發生慢性根尖病變產生囊腫，常會破壞波將黏膜形成瘻管。隨著囊腫發炎時間越久且瘻管開口變大，食物殘屑等異物易掉入管腔、進入囊腫造成發炎。所以面對瘻管開口大的囊腫進行根管治療時，需尋求適當的方法避免異物掉入瘻管。本病例報告為患者主訴上顎常常反覆腫脹，經檢查發現硬腭左邊皺摺區黏膜出現直徑5mm瘻管開口，經馬來膠針追蹤發現瘻管來自在上正中門齒根尖囊腫（直徑30mm）。因從未治療，加上用餐後食物掉入瘻管管腔，造成病人硬腭反覆腫脹不舒服。所以在左上正中門齒根管治療前，先製做上顎壓克力將板覆蓋瘻管開口，請病人於用餐前栽上，避免食物掉入瘻管。在根尖手術一個月後確定瘻管開口變小且無法連接至根尖病變區域才移除，左上正中門齒根尖囊腫術後四年追蹤癒合良好。本病例報告顯示上顎壓克力腭板除了使用在上顎硬腭區域翻瓣手術的初步癒合，也可輔助治療巨大根尖囊腫導致的硬腭皱摺區黏膜大型瘻管開口。

關鍵字

壓克力腭板 ； 根尖囊腫 ； 瘻管

並列摘要

It is known that the upper anterior teeth usually possess distopalatally curved apices. Once a cystic lesion due to a chronic infection occurs causing destruction of the hard palate and formation of a sinus tract, oral bacteria may gain access to the root apex via the sinus tract opening. The longer cystic inflammation exists, the larger the opening of the sinus tract will become, resulting in entrapment of food debris in the lesion. Therefore, when attempting to treat a large cyst with a big sinus tract opening, it is necessary to use an appropriate technique to avoid foreign objects being entrapped in the cystic lesion via the sinus tract. In the present case, a young male patient complained of frequent swelling around the palatal area over the past few years. Upon a clinical examination, a sinus tract of about 5 mm in diameter was identified over the left portion of the ruga area. By gutta percha tracing through the tract, a radiolucent lesion of about 30 mm in diameter was found around the apical area of the upper left central incisor. As a result of the untreated cystic lesion and the usual entrapment of food particles in the sinus tract via the large opening, the patient felt frequent discomfort from the swelling over the maxilla. Therefore, before endodontic treatment was initiated, an acrylic palatal plate was produced for the patient to wear before and during meals to prevent the entrapment of food debris in the tract. One month after surgery, when the primary closure and disconnection of the opening of the sinus tract from the apical infected area were confirmed, the patient was allowed to stop wearing the acrylic plate. The 4-year follow-up showed almost complete healing of the cystic lesion. According to the current case report, an acrylic palatal plate is useful not only for primary closure during flap surgery, but also for supplementary treatment of a large apical lesion with a big sinus tract.

並列關鍵字

acrylic resin palatal plate ； sinus tract ； radicular cyst