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1、鼻內(nèi)鏡下犬齒窩徑路治療上頜竇病變【摘要】探討一個損傷少，方便快捷且效果好的鼻內(nèi)鏡下的上頜竇手術(shù)方案治療上頜竇病變。方法：2002年3月至今，設(shè)計在患側(cè)唇齦溝第三齒上方做一縱形切口1l?5?cm,分離至犬齒窩骨質(zhì)，用骨鑿或電鉆做l?cm左右的骨孔，清除此處的上頜竇黏膜，置入鼻內(nèi)鏡，檢查上頜竇內(nèi)的病變情況，如果為上頜竇黏膜下囊腫，去除囊壁，妥善止血；上頜竇自然竇口正常者，無須擴(kuò)大竇口，在上頜竇內(nèi)的創(chuàng)面上和犬齒窩骨窗處貼附止血紗布，縫合2針，也可以應(yīng)用耳腦膠粘合。如果為上頜竇息肉，處理方法基本同上頜竇囊腫。如果為上頜竇曲菌病，就需要擴(kuò)大上頜竇自然竇口11.5?
2、cm,鼻腔內(nèi)可不必填塞，如需擴(kuò)大自然竇口，可填塞膨脹海綿。結(jié)果：36例均一期愈合，鼻腔通暢，癥狀消失，經(jīng)過4個月4年的隨訪觀察，未見病變復(fù)發(fā)，僅2例有短暫的唇部麻木，78?d后康復(fù)。2例擴(kuò)大自然竇口處有肉芽生長，經(jīng)處理后肉芽消失。結(jié)論：本術(shù)式有視野清晰，處理病變方便，并發(fā)癥少，不宜發(fā)生嚴(yán)重的反應(yīng)，竇口引流自然，符合上頜竇黏膜的正常生理特占八、o【關(guān)鍵詞】上頜竇外科手術(shù)犬齒窩[ABSTRACT]Objective:Operationinthemaxillarysinustendstoinjurethedebouchementofthenasolacrim
3、alcanalintheinferiornasalmeatusandthewallsofthefossaorbitalis.Wetriedtofindaprogramwiththeleastinjury,durationandthatwasthemostconvenience.Methods:FromMarch2002tothepresent，wedesignedanuprightcutof1to1.5cminthesidelabiogingivalgrooveofthei11sideabovethecaninetooth,separatedtotheb
4、oneincaninefossa,drilledaholeof1cmwithanosteotomeorelectrodri11,removedthelocalmucosa,insertedanendoscope,andinspectedthelesionsinside.Ifsubmucouscystswerefound,thecapsulewallwasremovedandproperhemostasiswasperformed;ifthemucosawasnormal,therewasnoneedtoenlargetheaperture,anabsor
5、bablehemostaticgauzewaslaidinthewoundsurfaceandthehole,andsuturedwith2stitches;oradheredwithbiologicalglue.Inpatientswithanantralpolyp,themanagementwasthesameasthecaseswithsumucosacyst.Inpatientswithaspergillosis,weenlargedtheaperturesto11.5?cm，didnotpackthenasalcavity,ifweenlarg
6、edtheapertures,wemaypackexpansivesponge.Thefacewasoppressedwithafourheadbelt,theplugwastakenoutafter48or72hoursaccordingtothepathogeneticcondition,andstitchesweretakenoutafter4or5days.Results：Primaryhealingwasfoundinall36cases,withanunobstructednasalcavityanddisappearanceofthesym
7、ptom.Norelapsewasfoundintheperiodoffourmonthstofouryearsoffollowup;only2casescomplainedabouttransientnumbnessintheupperlips.Al1patientsrecoveredafter78days.Granulationswerefoundintheenlargedaperturein2cases,andtheydisappearedaftertreatment.Conclusion:Thefeatureoftheoperationisthe
8、smalluprightcutinthelabiogingivalgrooves
