牙源性上颌鼻窦炎与异位2.8相关的滤泡性牙性囊肿:经鼻和口腔内镜联合入路1例报告

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Alveolus of 1.6 previosuly extracted\nwas evident.\nThe radiological examination, facial CT, revealed the left maxillary sinus almost completely occupied by a cystic appearance, with thin calcified\nwalls and homogeneous content that has a dental element, probably the 2.8, which fenestrates the vestibular cortex of the lateral wall of the\nmaxillary sinus. This lesion erodes the medial wall of the sinus, obliterating the ostio-meatal complex and imprinting the ipsilateral ethmoidal cells.\nBiohumoral tests showed normal coagulation parameters, indices of renal function, liver and ionemia.\nThe patient under general anesthesia and oral intubation with a combined intervention of the left anterior FESS, intrasulcular flap from dental\nelements 2.7 to 2.3 with mesial releasing incision, moderate osteotomy, ectopic 2.8 extraction and enucleation of the cystic lesion with simultaneous\nclosure of the orosinusal communication with advancement of the Bichat adipose bolla and closure by first intention.\nIn the same session, the ENT moment is carried out trans nasally for total left uncinectomy, medium antrostomy with the union of the natural ostium\nand the accessory ostium. 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引用次数: 0

摘要

目的:探讨经鼻内镜联合口腔联合治疗口腔黏膜病变的方法。方法:54岁的患者对疑似异位元2.8牙滤泡囊肿的左牙源性上颌鼻窦炎进行了牙科和耳鼻喉科检查。入院时报告的症状是鼻塞和夜间鼻病。硬光学内镜下耳鼻喉科评价,鼻中隔复杂偏曲与未见明显病理分泌物形成有关。在口腔检查中,粘膜未见损伤。先前提取的1.6个肺泡明显。放射学检查,面部CT显示左侧上颌窦几乎完全被囊性外观所占据,具有薄钙化壁和均匀的含有牙元素的内容物,可能是2.8,这是上颌窦侧壁前庭皮层的开窗。这种病变侵蚀鼻窦内侧壁,使口-金属复合体消失,并使同侧筛细胞留下印记。生物体液试验显示凝血参数、肾功能、肝脏指标及离子血症正常。患者在全身麻醉和口腔插管下,采用左前FESS联合干预,从牙元2.7到2.3的血管内皮瓣与近中释放切口,适度截骨,异位2.8的囊性病变的取出和去核,同时封闭口鼻交通与Bichat脂肪球的推进,并首次关闭。在同一疗程中,经鼻进行耳鼻喉科手术,用于全左鼻窦切除术,中口造口与自然口和副口结合。双极钳双侧下鼻甲成形术。术后15天和6个月,患者恢复良好,口腔检查鼻镜检查无复发迹象。结果:基于临床和影像学检查,从微生物学和组织学检查得出诊断为滤泡性牙性囊肿(WHO 2017),该囊肿被多层非角化铺路上皮覆盖,伴有中度慢性炎症,包括巨细胞和胆固醇晶体。坏死的无定形物质共存,包括罕见的菌丝和真菌孢子,因此真菌和放线菌的超级感染。结论:口腔外科医师与耳鼻喉科医师合作,采用口鼻联合干预,缩短了愈合时间,消除了病理,无复发迹象。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Maxillary sinusitis of odontogenic origin in relation to ectopic 2.8 associated with follicular dentigerous cyst: Combined transnasal and oral endoscopic approach, a case report
Purpose of the study: To describe the management of orosinusal pathology by combined transnasal endoscopy and oral combined. Methods: The 54-year-old patient underwent a dental and otolaryngological evaluation for left odontogenic maxillary sinusitis in relation to plausible dental follicular cyst of ectopic element 2.8. The symptoms reported at the time of access to the hospital were nasal obstruction and nocturnal rhonchopathy. To the ENT evaluation in videorinoscopy with rigid optics, complex deviation of the nasal septum was relevated with not any evident formations or pathological secretions. While on inspection of the oral cavity the mucous membranes appeared unscathed. Alveolus of 1.6 previosuly extracted was evident. The radiological examination, facial CT, revealed the left maxillary sinus almost completely occupied by a cystic appearance, with thin calcified walls and homogeneous content that has a dental element, probably the 2.8, which fenestrates the vestibular cortex of the lateral wall of the maxillary sinus. This lesion erodes the medial wall of the sinus, obliterating the ostio-meatal complex and imprinting the ipsilateral ethmoidal cells. Biohumoral tests showed normal coagulation parameters, indices of renal function, liver and ionemia. The patient under general anesthesia and oral intubation with a combined intervention of the left anterior FESS, intrasulcular flap from dental elements 2.7 to 2.3 with mesial releasing incision, moderate osteotomy, ectopic 2.8 extraction and enucleation of the cystic lesion with simultaneous closure of the orosinusal communication with advancement of the Bichat adipose bolla and closure by first intention. In the same session, the ENT moment is carried out trans nasally for total left uncinectomy, medium antrostomy with the union of the natural ostium and the accessory ostium. Bilateral lower turbinoplasty with bipolar forceps. The patient was then controlled after 15 days and six months, showing good healing and no signs of recurrence at the rhinoscopic check on the physical examination of the oral cavity. Results: based on the clinical and radiological aspect, the diagnosis of a follicular dentigerous cyst (WHO 2017) covered by a multi-layered non-keratinized paving epithelium, with moderate chronic inflammation, including gigantocellular and cholesteric crystals, is reached from the microbiological and histological examination. Necrotic amorphous material coexists including rare hyphae and fungal spores, with therefore mycotic and actinomycotic super infection. Conclusions: The combined oral and nasal intervention, allowed by the collaboration between the oral surgeon and ENT, has made it possible to shorten the healing time and to resolve the pathology without any sign of recurrence.
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