口腔矫治器配合开窗引流术治疗儿童发育期含牙囊肿的临床应用(1)
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[摘要]目的：研究口腔矫治器配合开窗引流术治疗儿童发育期含牙囊肿保留恒牙胚的临床疗效。方法：对30例替牙期儿童发育期含牙囊肿病例，采用口腔矫治器配合口腔颌面外科手术开窗引流保留恒牙胚的方法进行治疗。随访观察1～2年，根据X线片和临床症状评价疗效。结果：术后6～12个月囊腔阴影消失，牙齿萌至龈缘，牙根形成良好。13～18个月牙齿大多正常萌出，咬合关系良好。结论：口腔矫治器配合开窗引流手术治疗儿童发育期含牙囊肿效果良好，能够达到保牙和保骨的效果，值得临床推广应用。
[关键词]口腔矫治器；开窗引流手术；含牙囊肿
[中图分类号]R783.5 [文献标识码]A [文章编号]1008-6455(2011)07-1154-02
Clinical application of oral appliance cooperating with fenestration and decompression technique in treatment of dentigerous cyst in children
LI Mei-xia,SHEN Xiu-mei,LI Yu-gang
(Department of Stomatology,The Third Hospital of Handan,Handan 056001,Hebei,China)
Abstract:ObjectiveTo study the clinical effect of oral appliance cooperated with fenestration and decompression technique in treatment of dentigerous cyst in children.Methods Thirty cases were included in the study.The affected tooth germs were all reserved.The following up was from 1year to 2 year.The results were evaluated according to the X-ray film and clinical examination. ResultsCyst cavity disappeared in 6 to 12 months after treatment,and the teeth germ erupted to gingival margin,the theeth root took shape well.In 13 to 18 months after treatment,most tooth erupted normally,the occlusion was good. ConclusionThe clinical effects of oral appliance cooperated with fenestration in treatment of dentigerous cyst in children was satisfactory.All affected tooth were reserved and erupted normally.
Key words:oral appliance;fenestration and decompression technique;dentigerous cyst
儿童发育期含牙囊肿临床手术治疗时，多将含牙与囊壁同时刮除，结果造成术后缺牙和错牙合畸形。笔者收集2008～2010年来我院就诊的30例替牙期儿童发育期含牙囊肿病例，采用口腔矫治器配合开窗引流手术治疗儿童发育期含牙囊肿保留恒牙胚，使患者保存了牙列的完整性，省去了将来修复之痛苦，疗效良好。
1资料和方法
1临床资料：本研究选择2008～2010年来我院就诊的30例替牙期儿童发育期含牙囊肿需手术治疗患者。其中男性19例，女性11例，患者年龄7～12岁，下颌双尖牙区23例，下颌第二磨牙区2例，上颌尖牙区3例，上颌双尖牙区2例。其中有1例患者术后随访丢失。适应证：儿童发育期含牙囊肿，冠周囊肿大于0.5cm×0.5cm者。
1.2方法
1.2.1诊断：发病缓慢，病程较长，颌骨有膨隆，囊肿相应部位可见龋坏严重的乳牙，有牙痛史和治牙史。拍曲面断层片X线特点：病区为透影区，周围为致密的白线环绕，边界清晰，囊内有正在发育的恒牙胚，位置可正常或不正常，囊肿大者可显示累及临近恒牙牙根。
1.2.2取全口模型制作口腔矫治器：术前取全口模型，在模型上去除囊肿上方病灶牙，自牙槽嵴顶向囊腔挖一深约1cm直径0.6cm的洞，弯制固位卡环，自凝塑料糊塑矫治器，向洞中插入一段输液管，在囊肿处形成一中空囊肿塞引流管。
1.2.3手术：采用唇侧翻瓣手术，沿龈缘角形切口，掀起粘骨膜瓣，暴露颌骨皮质骨，用骨凿或咬骨钳去除菲薄的骨质，暴露囊腔，在骨窗下尽可能多地刮除囊壁组织，术中注意保护囊内恒牙胚，拔除囊肿上方乳牙，囊腔内置入碘仿纱条，纱条末端自拔牙创处引出，缝合唇侧伤口，术中试戴矫治器。
1.2.4戴入矫治器：术后3天取出囊腔内碘仿纱条，戴入矫治器，将囊肿塞自引流口插入，调磨合适，嘱饭后刷牙，冲洗矫治器，术后1个月内每周复诊1次。囊肿塞随牙齿萌出逐渐磨短，恒牙胚萌至龈下时，将矫治器改为缺隙保持器。
1.2.5术后随访：患者术后定期门诊复查，随访1～2年，包括局部检查和术后X线片检查，观察恒牙萌出及骨组织愈合情况 ......
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