Comparative study of the CBCT findings of odontogenic maxillary sinusitis caused by 3 different chronic oral inflammations
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摘要:
目的 比较单纯慢性牙周炎、牙周牙髓联合病变及慢性根尖周炎引起牙源性上颌窦炎（OMS）的影像学特征，探讨3种口腔慢性炎症导致的骨质破坏情况与上颌窦粘膜的形态学变化。 方法 选择未经治疗的3种口腔慢性炎症引起OMS患者各50例，对其锥形束CT影像学表现进行分析和精确测量，记录病源牙及其周围骨质破坏情况、上颌窦炎性肥厚的最大厚度值（DSM），进行统计分析。 结果 3种OMS中，病源牙为上颌第一磨牙者最多，占35.33%；其次为上颌第三磨牙，占27.33%；再次为上颌第二磨牙，占20.00%；病源牙超过2颗者占14.67%。颊/腭侧骨壁破坏患者上颌窦粘膜DSM为9.04±5.04 mm，高于无颊/腭侧骨壁破坏患者的6.94±5.03 mm（t=2.560，P=0.011）；上颌窦底壁瘘患者上颌窦DSM为11.49±6.68 mm，高于无上颌窦底壁瘘患者的6.67±3.75 mm（t=5.541，P<0.001）。单纯慢性牙周炎、牙周牙髓联合病变及慢性根尖周炎上颌窦底壁瘘发生率分别为40%、34%和24%，组间差异无统计学意义（χ2=2.703，P=0.259）。单纯牙周炎源性（9.26±5.33 mm）和牙周牙髓联合病变（10.24±4.93 mm）的DSM显著高于慢性根尖周炎（4.26±2.49 mm）（F=26.157, P<0.001）。 结论 单纯慢性牙周炎和牙周牙髓联合病损骨质破坏范围较广，上颌窦粘膜炎性肥厚改变的程度较重，相对于慢性根尖周炎更易发生牙源性上颌窦炎。 Abstract:Objective To compare the imaging characteristics of odontogenic maxillary sinusitis (OMS) caused by simple chronic periodontitis, combined periodontal-endodontic lesions and chronic periapical periodontitis and to analyze the correlation between the morphological changes of schneiderian membrance (DSM) and the bone damage caused by 3 types of chronic oral inflammations. Methods A total of 150 untreated OMS cases were selected, with 50 cases for each type of chronic oral inflammation, and all subjects received CBCT scan, the result of which was acutely measured and analyzed. Pathogenic teeth and the surrounding bone damage were recorded, and the axillary sinus mucosal thickness was measured in sagittal and coronary position. Results The most common pathogenic teeth were the maxillary first molar (35.33%), followed by the maxillary third molar (27.33%) and the maxillary second molar (20.00%). There were 14.67% patients with more than 1 pathogenic tooth. The DSM (9.04±5.04 mm) in cases with buccal/palatal lateral bone damage was significantly higher than that without buccal/palatal lateral bone damage (6.94±5.03 mm）（t=2.560, P=0.011）. The DSM in cases with oral-maxillary fistula (11.49±6.68 mm) was significantly higher than that without oral-maxillary sinus fistula (6.67±3.75 mm）（t=5.541, P<0.001）. The incidences of oral-maxillary fistula in chronic periodontitis, periodontal-endodontic combined lesions and chronic apical periodontitis were 40%, 34% and 24% respectively. There were no statistically significant differences among the 3 groups （x= 2.703, P= 0.259）. The DSMs in both groups of chronic periodontitis and periodontal-endodontic combined lesions were significantly higher than that in chronic apical periodontitis group (4.26±2.49 mm) （F= 26.157, P<0.001） Conclusion Odontogenic maxillary sinusitis is more likely to happen in cases with chronic periodontitis and periodontal-endodontic combined lesions, in which the range of maxillary bone damage and extent of the maxillary sinus mucosa thickening are larger than those in cases with chronic apical periodontitis. -
表 1 病源牙牙位情况[n（%）]
分组 第一磨牙 第二磨牙 第三磨牙 前磨牙 前牙 病源牙数目≥2 慢性成人牙周炎组 20（13.33） 8（5.33） 11（7.33） 0（0） 0（0） 11（7.33） 牙周牙髓联合病变组 15（10.00） 12（8.00） 18（12.00） 0（0） 0（0） 5（3.33） 慢性根尖周炎组 18（12.00） 10（6.67） 12（8.00） 3（2.00） 1（0.67） 6（4.00） 总计 53（35.33） 30（20.00） 41（27.33） 3（2.00） 1（0.67） 22（14.67） 
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表 2 不同性别、病源牙数、颊腭侧骨壁破坏情况、底壁瘘对上颌窦粘膜DSM的影响（Mean±SD）
变量 人数（n） 最大厚度值（mm） t/F P 性别 男 99 8.30±4.87 1.251 0.213 女 52 7.19±5.57 病源牙数目 1 128 7.57±4.48 3.679 0.028 ≥2 22 10.84±8.23 颊腭侧骨壁破坏 有 70 9.04±5.04 2.560 0.011 无 80 6.94±5.03 上颌窦底壁瘘 有 39 11.49±6.68 5.541 <0.001 无 111 6.67±3.75
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表 3 3组各指标差异比较[n=50，（%）]
变量 慢性牙周炎组 牙周牙髓联合病变组 慢性根尖周炎组 F/χ2 P 年龄 58.12±10.81 53.84±12.46 35.60±12.16# 51.081 <0.001 性别 男 43（28.67）# 31（20.67） 25（16.67） 14.973 0.001 女 7（4.66） 19（12.67） 25（16.67） 病原牙数目 1 39（26.00） 45（30.00） 44（29.33） - 0.121 ≥2 11（7.33） 5（3.33） 6（4.00） 颊/腭侧骨壁破坏 有 42（28.00） 30（20.00） 8（5.33） 47.786 <0.001 无 8（5.33） 20（13.33） 42（28.00） 上颌窦底壁瘘 有 20（13.33） 17（11.33） 12（8.00） 2.703 0.259 无 30（20.00） 33（22.00） 38（25.33） DSM（mm） 9.26±5.33 10.24±4.93 4.26±2.49 26.157 <0.001 #P<0.05vs 其他两组.
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[1] Mehra P, Jeong D. Maxillary sinusitis of odontogenic origin[J]. Curr Allergy Asthma Rep, 2009, 9（3）: 238-43. doi: 10.1007/s11882-009-0035-0 [2] Bhatta CN. Contemporary assessment of the disease burden of sinusitis[J]. Am J Rhinol Allergy, 2009, 23（8）: 392-5. https://www.researchgate.net/publication/26732778_Contemporary_assessment_of_the_disease_burden_of_sinusitis [3] Melen I, Lindahl L, Andrcasson L, et al. Chronic maxillary sinusitis:definition,diagnosis and relation to dental infections and nasal polyposis[J]. Acta Otolaryngol, 1986, 101（3/4）: 320-7. [4] Longhini AB, Branstetter BF, Ferguson BJ. Unrecognized odontogcnic maxillary sinusitis:a cause of endoscopic sinus surgery failure[J]. Am J Rhinol Allergy, 2010, 24（4）: 296-300. doi: 10.2500/ajra.2010.24.3479 [5] Kretzschmar DP, Kretzschmar JL. Rhinosinusitis:review from a dental perspective[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2003, 96（2）: 128-35. doi: 10.1016/S1079-2104(03)00306-8 [6] Richtsmeier WJ. Top 10 reasons for endoscopic maxillary sinus surgery failure[J]. Aryngoscope, 2001, 111（7）: 1952-6. [7] Shanbhag S, Karnik P, Shirke PA. Association between periapical lesions and maxillary sinus mucosal thickening: a petrospective cone-beam computed tomographic study[J]. J Endod, 2013, 39（7）: 853-7. doi: 10.1016/j.joen.2013.04.010 [8] Bomeli SR, Branstetter BF, Ferguson BJ.Frequency of a dental source for acute maxillary sinusitis[J]. Ryngoscope, 2009, 119（3）: 580-4. doi: 10.1002/lary.20095/abstract [9] Andric M, Saranovic V, Drazic R, et al. Functional endoscopic sinus surgery as an adjunctive treatment for closure of oroantral fistulae:a retrospective analysis[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010, 109（4）: 510-6. doi: 10.1016/j.tripleo.2009.10.028 [10] Costa F, Emanuelli E, Robiony M, et al. Endoscopic surgical treatment of chronic maxillary sinusitis of dental origin[J]. J Oral Maxillofac Surg, 2007, 65（2）: 223-8. doi: 10.1016/j.joms.2005.11.109 [11] Patel N, Ferguson BJ. Odontogenic sinusitis: an ancient but underappreciated cause of maxillary sinusitis[J]. Curr Opin Otolaryngol Head Neck Surg, 2012, 20（9）: 24-8. https://www.researchgate.net/publication/51867289_Odontogenic_sinusitis_An_ancient_but_under-appreciated_cause_of_maxillary_sinusitis [12] Arias O, Barona DC, Santos JA, et al. Meta-analsis of the etiology of odontogenie maxillary sinusitis[J]. Med Oral Patol Oral Cir Bucal, 2010, 15（1）: e70-3. [13] 李功臣, 陆永健, 徐泽淼, 等. 应用CBCT回顾分析牙源性上颌窦病变[J]. 口腔医学, 2015, 35（03）: 192-6. [14] Buskina AV, Gerber V. Clinical classification of chronic odontogenic maxillary sinusitis[J]. Vestn Otorinolaringol, 2000, 2（8）: 20-2. [15] 曹采方. 牙周病学[M]. 北京: 人民卫生出版社, 2000: 119-35. [16] 樊明文. 牙体牙髓病学[M]. 北京: 人民卫生出版社, 2000: 186-8. [17] Ugincius P, Kubilius R, Gervickas A, et al. Chronic odontogenic maxillary sinusitis[J]. Stomatology, 2006, 8（11）: 44-8. [18] Hajhoannou J, Koudounarakis E, Alexopoulos K, et al. Maxillary sinusitis of dental origin due to oroantral fistula, treated by endoscopic sinus surgery and primary fistula closure[J]. J Laryngol Otol, 2010, 124（9）: 986-9. doi: 10.1017/S0022215110001027 [19] Lcgcrt KG, Zimmcrman M, Sticrna P. Sinusitis of odontogenic origin;pathophysiological implications of early treatment[J]. Acta Otolaryngol, 2004, 124（6）: 655-63. doi: 10.1080/00016480310016866 [20] Phothikhun S, Suphanantachat S, Chuenchompoonut V, et al. Cone bean computed tomographic evidence of the association between periodontal bone loss and muccosal thickening of the maxillary sinus[J]. J Periodontol, 2012, 83（5）: 557-64. doi: 10.1902/jop.2011.110376 [21] Lu Y, Liu ZJ, Zhang L, et al. Associations between maxillary sinus mucosal thickening and apical periodontitis using cone-beam computed tomography scanning: a retrospective study[J]. J Endod, 2012, 38（8）: 1069-74. doi: 10.1016/j.joen.2012.04.027 [22] 任 颂, 刘静波, 赵海礁, 等. 中重度广泛型侵袭性牙周炎患者上颌窦黏膜形态变化特点及相关性研究[J]. 口腔医学研究, 2013, 15（11）: 1034-8. http://www.cnki.com.cn/Article/CJFDTotal-XCYS201615058.htm [23] Abrahams JJ, Glassberg RM. Dental disease:a frequently unrecognized cause of maxillary sinus abnormalities[J]. Am J Roentgenol, 1996, 166（12）: 1219-23. [24] Engstrom H, Chamberlain D, Kiger R, et al. Radiographic evaluation of the effect of initial periodontal therapy on thickness of the maxillary sinus mucosa[J]. J Periodontol, 1988, 59（8）: 604-8. [25] 阮德成, 马 敏. MTA应用于显微根尖手术治疗慢性根尖周炎的效果观察[J]. 口腔疾病防治, 2017, 25（03）: 180-2. [26] 高 燕, 蒋晓琼. 口腔手术显微镜在非手术根管治疗中的应用[J]. 口腔疾病防治, 2017, 25（06）: 341-6. -
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