口腔医学研究

口腔医学研究 ›› 2021, Vol. 37 ›› Issue (3): 246-249.DOI: 10.13701/j.cnki.kqyxyj.2021.03.014

• 口腔颌面外科学研究 • 上一篇    下一篇

儿童下颌第二磨牙冠周炎致下颌骨骨髓炎的临床诊治

张立刚, 易杰, 张霓霓, 姚礼, 黄桂林*, 胡小华, 代敏, 任小清   

  1. 遵义医科大学口腔医学院·附属口腔医院·贵州省普通高等学校 口腔疾病研究特色重点实验室 贵州 遵义 566300
  • 收稿日期:2020-09-24 发布日期:2021-03-19
  • 通讯作者: *黄桂林,E-mail:chaojiehuanghgl@163.com
  • 作者简介:张立刚(1987~ ),男,山东枣庄人,硕士,讲师,主治医师,研究方向:口腔颌面部肿瘤的防治。
  • 基金资助:
    国家自然科学基金(编号:81760201);科技部国家“十三五”重点研发计划项目子课题(编号:2016YFC1102804);遵义医学院硕士启动基金(2016年度编号:KY2016-3#);遵义医学院附属口腔医院院基金(编号:KY2015-12);遵义市科学技术局、遵义医学院附属口腔医院联合科技研发资金项目(编号:遵市科合社字[2018]248);住院医师规范化培养院内教改基金项目(编号:2018-06)

Diagnosis and Treatment of Mandibular Osteomyelitis Caused by Pericoronitis of Mandibular Second Molars in Children

ZHANG Ligang, YI Jie, ZHANG Nini, YAO Li, HUANG Guilin*, HU Xiaohua, DAI Min, REN Xiaoqing   

  1. Department of Oral Maxillofacial Surgery, Hospital & School of Stomatology, Zunyi Medical University, Key Laboratory of Oral Disease of Higher School in Guizhou Province, Zunyi 56300, China
  • Received:2020-09-24 Published:2021-03-19

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摘要： 目的:探讨儿童下颌第二磨牙冠周炎导致下颌骨骨髓炎的临床特点及治疗方法。方法:选取2016年1月~2019年3月共收治10例儿童下颌第二磨牙冠周炎致下颌骨骨髓炎患者,平均年龄12.1岁,临床表现为面部肿胀、发硬、张口受限。10例患者均在全麻下行“下颌骨骨髓炎探查刮治活检术+冠周龈瓣切除术”,预防性“拔除下颌第三磨牙胚”。病变发生于下颌体、下颌角及下颌升支,以颊侧为主,9例出现骨质破坏,10例病例可见较广泛的骨质增生硬化、与颌骨平行的骨膜新生骨。结果:10例患者术后口内创口均愈合良好,面部肿胀消退,张口度改善,3月后复查锥形束CT显示骨质缺损区范围逐渐缩小,病变颌骨可重新塑形解剖结构接近正常。结论:儿童下颌第二磨牙冠周炎所致下颌骨骨髓炎患者的发生年龄小,早期诊断与治疗有助于防止下颌骨破坏加重,避免下颌骨发育畸形、病理性骨折及面部畸形;对于以颊侧病变为主的骨髓炎病灶,经口内切口彻底行下颌骨骨髓炎刮治术取得良好的临床治疗效果。

关键词: 儿童, 下颌第二磨牙, 冠周炎, 下颌骨骨髓炎

Abstract: Objective: To investigate the clinical characteristics and treatment of mandibular osteomyelitis caused by pericoronitis of the second molar in children. Methods: From January 2016 to March 2019, a total of 10 children with osteomyelitis of mandible caused by pericoronitis of mandibular second molars were admitted and treated. The average age was 12.1 years old, and the clinical manifestations were facial swelling, stiffness, and limited mouth opening. All 10 patients underwent "mandibular osteomyelitis exploration and curettage biopsy and pericoronal gingival flap resection" under general anesthesia to prevent "extraction of mandibular third molars". The lesions occurred in mandibular body, mandibular angle and ascending ramus, mainly in buccal side. Bone destruction was observed in 9 cases. Extensive osteosclerosis with periosteal new bone parallel to the jaw bone was seen in 10 cases. Results: All 10 patients had good postoperative oral wound healing. The facial swelling subsided and mouth opening improved. The CBCT reexamination 3 months later showed that the area of bone defect was gradually reduced, and the anatomical structure of the diseased jaw could be reshaped close to normal. Conclusion: The patients with mandibular osteomyelitis caused by pericoronitis of mandibular second molars generally are children. Early diagnosis and treatment are helpful to prevent the destruction and aggravation of mandible and to avoid mandible developmental malformation, pathological fracture, and facial malformation. Curettage of mandibular osteomyelitis through an internal incision can achieve good clinical results for the lesions of buccal lesions.

Key words: children, mandibular second molars, pericoronitis, osteomyelitis of mandible