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目的探讨上颌根尖炎并发鼻旁感染和瘘管的诊断治疗方法。方法对12例上颌根尖炎并发鼻旁感染和瘘管的病例进行临床分析。12例患者行上颌骨CT或X线拍片检查上颌骨质未见异常,8例误诊为上颌骨骨髓炎(3例)、皮脂腺囊肿感染(2例)、鼻前庭囊肿感染(2例)和基底细胞癌(1例);12例均行牙片检查后诊断为牙源性鼻旁感染和瘘管;手术治疗采用瘘管局部切除(8例)、拔除病牙(10例)、清除根尖病灶(12例)或控制炎症后行根管治疗(2例)。结果 8例患者面部切口全部愈合,4例鼻旁感染控制炎症后进行牙齿拔出、根尖肉芽搔刮和抗炎治疗后未再复发,患者经过2个月~16年追踪观察,感染与瘘管未再复发。结论鼻旁感染与瘘管应首先考虑上颌牙齿根尖炎所致,进行口腔科检查会诊有助于减少误诊,进行瘘管局部切除和根管治疗,拔出患牙是必须的。
Objective To investigate the diagnosis and treatment of maxillary root tipitis complicated by nasal infection and fistula. Methods 12 cases of maxillary root tipitis complicated by nasal infection and fistula were analyzed. Twelve patients underwent maxillary CT or X-ray examination of the maxillary bone without abnormalities. Eight patients were misdiagnosed as maxillary osteomyelitis (3 cases), sebaceous cyst infection (2 cases), nasal vestibular cyst infection (2 cases) and basilar (1 case); 12 cases were diagnosed as odontogenic nasal infection and fistula after operation; 8 cases were treated by local fistula removal, 10 cases were removed, and the root tip lesions were removed 12 cases) or control inflammation after root canal therapy (2 cases). Results Eight cases of facial incision healed completely, 4 cases of nasal infection control inflammation after tooth extraction, root sprouting and anti-inflammatory granulation scratch recurrence, the patient after 2 months to 16 years follow-up observation, infection and fistula No recurrence. Conclusion Nasal infection and fistula should be considered first of the maxillary tooth root apical inflammation, dental consultation will help reduce misdiagnosis, local fistula resection and root canal therapy, pulling out the affected teeth is necessary.