首都医科大学学报 ›› 2024, Vol. 45 ›› Issue (2): 239-245.doi: 10.3969/j.issn.1006-7795.2024.02.011

• 慢性鼻窦炎机制和临床研究 • 上一篇    下一篇

有/无鼻窦炎症状的牙源性鼻窦炎患者的临床特征比较

郑  铭1,  吴健有2,  司马宇彤1,  王向东1，3，4,  张  罗1，3，4*   

  1. 1.首都医科大学附属北京同仁医院耳鼻咽喉头颈外科，北京 100730；　2.首都医科大学附属北京同仁医院口腔科，北京 100730; 3.北京市耳鼻咽喉科研究所，北京市中西医结合耳鼻咽喉科研究所，过敏性疾病北京实验室（北京市教育委员会），鼻病研究北京市重点实验室 耳鼻咽喉头颈科学教育部重点实验室（首都医科大学），北京 100005; 4.中国医学科学院慢性鼻病诊疗策略研究创新单元，北京 100005
  • 收稿日期:2024-01-18 出版日期:2024-04-21 发布日期:2024-04-25
  • 通讯作者: 张 罗 E-mail:dr.luozhang@139.com
  • 基金资助:
    国家重点研发计划项目(2022YFC2504100)，国家自然科学基金项目(81970852, 82171110), 教育部长江学者创新团队项目(IRT13082)，北京市自然科学基金项目(7222024)，中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-022)，首都卫生发展科研专项重点攻关项目(2022-1-1091)，首都医科大学科研培育基金（2020-1210020214）。

Comparison of clinical characteristics between odontogenic sinusitis patients with and without sinusitis symptoms

Zheng Ming1 , Wu Jianyou2 , Sima Yutong1, Wang Xiangdong1，3，4, Zhang Luo1，3，4 *   

  1. 1.Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730，China；2.Department of Stomatology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730，China；3.Beijing Laboratory of Allergic Diseases, Institute of Integrated Traditional Chinese and Western Medicine in Otolaryngology, Beijing Laboratory of Allergic Diseases (Beijing Municipal Education Commission)， Beijing Key Laboratory of Nasal Diseases, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University)，Ministry of Education, Beijing 100005，China；4.Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing 100005，China
  • Received:2024-01-18 Online:2024-04-21 Published:2024-04-25
  • Supported by:
    This study was supported by National Key R&D Program of China(2022YFC2504100), National Natural Science Foundation of China (81970852，82171110), Changjiang Scholars and Innovative Research Team (IRT 13082), Natural Science Foundation of Beijing (7222024) ，the CAMS Innovation Fund for Medical Sciences(2019-I2M-5-022), the Capital's Funds for Health Improvement and Research(2022-1-1091), the Scientific Research and Cultivation Fund of Capital Medical University (2020-1210020214).

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摘要： 目的  比较牙源性鼻窦炎（odontogenic sinusitis, ODS）患者中有鼻窦炎症状和无鼻窦炎症状群体的临床表现。方法  回顾性收集2020年6月至2022年6月在首都医科大学附属北京同仁医院耳鼻咽喉头颈外科行内镜鼻窦手术的92例ODS患者的临床资料，77例有鼻窦炎症状（sinusitis symptoms，SS 组），15例无鼻窦炎症状（non-SS 组）。比较两组患者的病史、症状、病因、内镜检查和鼻窦电子计算机断层扫描（computed tomography，CT）等。结果  non-SS 组患者相比SS 组患者的病程更短［(4.9±3.4)个月vs (10.4±11.0)个月, P=0.048］，首诊口腔科比例更高（100% vs 24.7%, P=0.035）。两组患者报告牙痛、牙齿松动症状阳性率，差异无统计学意义(29.9% vs 53.3%，P=0.133; 18.2% vs 35.3%, P=0.085)。牙周-牙髓联合病变（periodontal-endodontic combined lesions， PECL）、根尖周炎（apical periodontitis，AP）、牙周炎（periodontitis, PE）、医源性占SS组和non-SS组患者病因的比例分别为53.2% vs 20%（P= 0.024）、28.6% vs 33.3%（P=0.76）、11.7% vs 26.7% （P=0.215）、 6.5% vs 20% （P=0.119）。鼻窦CT显示，与non-SS 组患者相比，SS 组患者窦口鼻道复合体（ostiomeatal complex, OMC）、筛窦、额窦有更高比例的受累（83.1% vs 26.7%, P=0.000; 80.5% vs 20%, P=0.000; 41.6% vs 0%, P=0.002）。结论  耳鼻喉科与口腔科的多学科合作，可以早期发现无鼻窦炎症状的ODS，及时诊治PECL等牙齿相关性疾病，减少内镜手术概率，提升患者生活质量。

关键词: 牙源性鼻窦炎, 临床特征, 鼻窦CT, 症状, 牙周-牙髓联合病变

Abstract: Objective  To compare the differences of clinical manifestation between odontogenic sinusitis (ODS) patients with and without sinusitis symptoms. Methods  The clinical data of totally 92 ODS patients’ clinical data were retrospectively collected, who underwent endoscopic sinus surgery in the Department of Otolaryngology, Head and Neck Surgery in Beijing TongRen Hospital, Capital Medical Uniersity, from June 2020 to June 2022. Among them, 77 cases had sinusitis symptoms（SS group）, and 15 cases had no sinusitis symptoms（non-SS group）. The survey items included medical history, symptoms, etiology, endoscopic examination and sinus computed tomography(CT)were compared.Results  Compared with the SS group, the non-SS group has a shorter course of disease ［(4.9 ± 3.4) months vs (10.4 ± 11.0) months, P=0.048)］, and a higher proportion of first consultation in Department of Stomatology (100% vs 24.7%, P=0.035). There was no statistically significant difference in the positive rates of reported toothache and tooth loosening symptoms between the two groups of patients (29.9% vs 53.3%, P=0.133; 18.2% vs 35.3%, P=0.085). The proportion of periodontal endodontic combined lesions (PECL), apical periodontitis (AP), periodontitis (PE), and iatrogenic factor, accounted for the etiology of the two groups of patients, were 53.2% vs 20% (P=0.024); 28.6% vs 33.3% (P=0.76); 11.7% vs 26.7% (P=0.215); and 6.5% vs 20% (P=0.119), respectively. CT of the sinuses showed that the SS group had a higher proportion of involvement in the ostiomeatal complex (OMC), ethmoid sinus, and frontal sinus than non-SS group did, with 83.1% vs 26.7% (P=0.000); 80.5% vs 20% (P=0.000);  and 41.6% vs 0% (P=0.002), based on the evaluation of CT opacification. Conclusions  The multidisciplinary cooperation between Otolaryngology and Stomatology could early identify ODS patients without sinusitis symptoms, diagnose and treat timely dental related diseases, such as PECL, reduce the probability of endoscopic sinus surgery, and improve life quality of  patients. 

Key words: odontogenic sinusitis, clinical characteristics, sinus CT, symptom,  , periodontal-endodontic combined lesions

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