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1、毕业论文名:2014年6月25日鼻内镜下犬齿窝径路治疗上颌窦病变【摘要】探讨一个损伤少，方便快捷且效果好的鼻内镜下的丄颌窦手术方案治疗上颌窦病变。方法：2002年3月至今，设计在患侧唇龈沟第三齿丄方做一纵形切口11.5?cm,分离至犬齿窝骨质，用骨凿或电钻做l?cm左右的骨孔，清除此处的上颌窦黏膜，置入鼻内镜，检查丄颌窦内的病变情况，如果为丄颌窦黏膜下囊肿，去除囊壁，妥善止血；上颌窦自然窦口正常者，无须扩大窦口，在上颌窦内的创面上和犬齿窝骨窗处贴附止血纱布，缝合2针，也可以应用耳脑胶粘合。如果为丄颌窦息肉，处理方法基本
2、同上颌窦囊肿。如果为丄颌窦曲菌病，就需要扩大上颌窦自然窦口1l・5?cm,鼻腔内可不必填塞，如需扩大自然窦口，可填塞膨胀海绵。结果：36例均一期愈合，鼻腔通畅，症状消失，经过4个月4年的随访观察，未见病变复发，仅2例有短暂的唇部麻木，78?d后康复。2例扩大自然窦口处有肉芽生长，经处理后肉芽消失。结论：本术式有视野清晰，处理病变方便，并发症少，不宜发生严重的反应，窦口引流自然，符合上颌窦黏膜的正常生理特点。【关键词】上颌窦外科手术犬齿'窝[ABSTRACT]Objective：Operationinthemaxilla
3、rysinustendstoinjurethedebouchementofthenasolacrimalcanalintheinferiornasalmeatusandthewallsofthefossaorbitalis.Wetriedtofindaprogramwiththeleastinjury,durationandthatwasthemostconvenience.Methods：FromMarch2002tothepresent,wedesignedanuprightcutof1to1.5cminthesi
4、delabiogingivalgrooveoftheillsideabovethecaninetooth,separatedtotheboneincaninefossa,drilledaholeof1cmwithanosteotomeorelectrodrill,removedthelocalmucosa,insertedanendoscope,andinspectedthelesionsinside.Ifsubmucouscystswerefound,thecapsulewallwasremovedandproper
5、hemostasiswasperformed;ifthemucosawasnormal,therewasnoneedtoenlargetheaperture,anabsorbablehemostaticgauzewaslaidinthewoundsurfaceandthehole,andsuturedwith2stitches;oradheredwithbiologicalglue.Inpatientswithanantralpolyp,themanagementwasthesameasthecaseswithsumu
6、cosacyst.Inpatientswithaspergillosis,weenlargedtheaperturesto11.5?cm,didnotpackthenasalcavity,ifweenlargedtheapertures,wemaypackexpansivesponge.Thefacewasoppressedwithafourheadbelt,theplugwastakenoutafter48or72hoursaccordingtothepathogeneticcondition,andstitches
7、weretakenoutafter4or5days.Results：Primaryhealingwasfoundinall36cases,withanunobstructednasalcavityanddisappearanceofthesymptom.Norelapsewasfoundintheperiodoffourmonthstofouryearsoffollowup;only2casescomplainedabouttransientnumbnessintheupperlips.Allpatientsrecov
8、eredafter78days.Granulationswerefoundintheenlargedaperturein2cases,andtheydisappearedaftertreatment.Conclusion：Thefeatureoftheoperationisthesmalluprightcutinthelabiog
