三维建模配准分析经口与经鼻开窗治疗上颌骨囊肿三维形态变化

doi:10.6040/j.issn.1673-3770.0.2023.437

摘要/Abstract

摘要： 目的通过三维建模及模型配准,分析经口与经鼻内镜鼻内开窗治疗上颌骨囊肿的体积及三维方向变化,探讨经鼻内镜鼻内开窗治疗上颌骨囊肿与经口开窗治疗的囊肿体积缩小的差异及其各自三维方向收缩变化。方法收集2019年6月至2022年6月滨州医学院附属烟台口腔医院确诊的上颌骨囊肿的患者资料,手术分为经口开窗、经鼻内镜鼻内开窗采用鼻底、下鼻道开窗两种方式,依据术前及术后拍摄的Cone-bean computed tomography,通过Materialise Mimics 21及3-matic软件三维重建,测量体积及近远中径、颊舌径、高度上的变化。结果得到两组术式开窗术后体积百分比与时间的回归模型:V₁=-0.007×t3+0.462×t2-10.175×t+99.481(P<0.001, R=0.956, adjusted R2=0.904);V₂=-0.018×t3+0.872×t2-13.834×t+99.978(P<0.001, R=0.964, adjusted R2=0.919),前6个月经鼻内镜鼻内开窗组体积收缩速度大于经口开窗组;22个月时经口开窗组囊腔体积基本保持稳定;囊腔变化稳定后两组体积相似。经口开窗组三维方向变化百分比与时间的回归模型:X₁=-2.23×10^-4×t3+0.074×t2-3.652×t+98.979(P<0.001,R=0.91, adjusted R2=0.811);Y₁=-0.005×t3+0.288×t2-5.638×t+100.028(P<0.001, R=0871, adjusted R2=0.734);Z₁=0.079×t2-3.880×t+97.633(P<0.001, R=0.917, adjusted R2=0.830);经鼻开窗组三维方向变化百分比与时间的回归模型:X₂=0.072×t2-3.346×t+98.80(P<0.001, R=0.945, adjusted R²=0.883);Y₂=-0.001×t3+0.127×t2-4.036×t+99.138(P<0.001, R=0.892, adjusted R2=0.766);Z₂=0.074×t2-3.758×t+99.209(P<0.001, R=0.961, adjusted R2=0.916)。经鼻内镜下鼻内开窗术后上颌骨囊肿以高度变化为主;经口开窗术后上颌骨囊肿以近远中径、高度变化为主。结论经口行上颌骨囊肿开窗治疗与经鼻内镜下鼻内开窗治疗上颌骨根尖囊肿,在体积收缩方面两者有相似的临床疗效,经鼻内镜下鼻内开窗治疗体积会更快的缩小。准确预测上颌骨根尖囊肿形态变化为临床工作提供一定的参考。

关键词: 上颌骨囊肿, 经口开窗, 鼻内镜下经鼻内开窗, 三维建模及模型配准, 回归模型

Abstract: Objective To analyse the volume and three-dimensional direction changes of maxillary bone cyst treated by endoscopic and transnasal fenestration through three-dimensional modelling and model registration, and to explore the difference in volume reduction and three-dimensional contraction of maxillary cyst treated by endoscopic and transnasal fenestration. Methods The data of patients with maxillary bone cyst diagnosed in Yantai Stomatological Hospital Affiliated to Binzhou Medical College from June 2019 to June 2022 were collected. The operation was divided into two methods: transoral fenestration, transnasal endoscopy intranasal fenestration with nasal base and inferior nasal canal fenestration. Materialise Mimics 21 and 3-matic software were used for 3D reconstruction to measure changes in volume, proximal and distal diameter, buccolingual diameter and height. Results The regression models of volume percentage and time of the two groups were obtained: V₁=-0.007×t3+0.462×t2-10.175×t+99.481(P<0.001, R=0.956, adjusted R²=0.904); V₂=-0.018×t3+0.872 t2-13.834×t+99.978(P <0.001, R=0.964, adjusted R²=0.919), the volume contraction rate of the endoscopic intranasal fenestration group was higher than that of the transoral fenestration group in the first 6 months. The capsule volume in the transoral window group remained stable at 22 months. The volume of the two groups was similar after stabilisation of the changes in the cystic cavity. The percentage change of the three-dimensional direction in the transoral fenestration group was adjusted by a regression model: X₁=-2.23×10^-4×t3+0.074×t2-3.652×t+98.979(P<0.001, R=0.91, adjusted R²=0.811); Y₁=-0.005×t3+0.288×t2-5.638×t+100. 028(P< 0.001, R=0871, adjusted R2=0.734); Z₁=0.079×t2-3.880×t+97.633(P<0.001, R=0.917, adjusted R2=0. 830); The regression model of percentage and time of 3D direction change of the nasal window group was as follows: X₂=0.072×t2-3.346×t+98.80(P<0.001, R=0.945, adjusted R²=0.883); Y₂=-0.001×t3+0.127×t2-4.036×t+99.138(P<0.001, R=0.892, adjusted R2=0.766); Z₂=0.074×t2-3.758×t+99.209(P<0.001, R=0.961, adjusted R²=0.916). The maxillary cyst changed mainly in height after intranasal fenestration under nasal endoscope. Maxillary cyst after transoral fenestration mainly changed in proximal and distal diameter and height. Conclusion Transoral fenestration for maxillary bone cyst and intranasal fenestration under nasal endoscope for maxillary apical cyst have similar clinical effects in terms of volume contraction, and intranasal fenestration under nasal endoscope will shrink the volume faster. Accurate prediction of morphological changes of maxillary apical cyst can provide some reference for clinical work.

Key words: Maxillary cyst, Transoral fenestration, Intranasal fenestration under nasal endoscopy, 3D modeling and model, Registration, Regression model

中图分类号:

R765.9

李晓宇,王彬晨,徐大朋,王艳华,杜平功,张庆泉. 三维建模配准分析经口与经鼻开窗治疗上颌骨囊肿三维形态变化[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 72-78.

LI Xiaoyu, WANG Binchen, XU Dapeng, WANG Yanhua, DU Pinggong, ZHANG Qingquan. Effectiveness of transnasal and transoral fenestration in the treatment of maxillary bone cysts[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(2): 72-78.

参考文献

[1] 陶谦, 何悦, 刘冰, 等. 开窗治疗颌骨囊性病变的专家共识[J]. 口腔疾病防治, 2020, 28(2): 69-72. doi:10.12016/j.issn.2096-1456.2020.02.001 TAO Qian, HE Yue, LIU Bing, et al. Expert consensus on marsupialization of cystic lesions of the jaw[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2020, 28(2): 69-72. doi:10.12016/j.issn.2096-1456.2020.02.001
[2] Lee JY, Baek BJ, Byun JY, et al. Comparison of conventional excision via a sublabial approach and transnasal marsupialization for the treatment of nasolabial cysts: a prospective randomized study[J]. Clin Exp Otorhinolaryngol, 2009, 2(2): 85-89. doi:10.3342/ceo.2009.2.2.85
[3] 李红金,王剑,来育斌,等.不同术式治疗上颌骨囊肿的疗效评价[J].山东大学耳鼻喉眼学报. 2024, 38(3): 33-37. doi: 10.6040 /j.issn.1673-3770.0.2023.053 LI Hongjin, WANG Jian, LAI Yubin, et al. Evaluation of different surgical methods in the treatment of maxillary cysts[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(3): 33-37. doi: 10.6040 /j.issn.1673-3770.0.2023.053
[4] Dereci Ö, Saruhan N, Tekin G, et al. Two-dimensional change in the cystic defects after decompression and enucleation of jaw cysts-A comparative study[J]. Ann Maxillofac Surg, 2021, 11(2): 241-246. doi:10.4103/ams.ams_122_21
[5] Nasseh I, Al-Rawi W. Cone beam computed tomography[J]. Dent Clin N Am, 2018, 62(3): 361-391. doi:10.1016/j.cden.2018.03.002
[6] 杜悦, 彭笑, 韩瑞, 等. 颌骨囊肿开窗治疗临床特征动态研究[J]. 上海口腔医学, 2021, 30(6): 658-662. doi:10.19439/j.sjos.2021.06.019 DU Yue, PENG Xiao, HAN Rui, et al. Clinical dynamic study of jaw cyst after decompression[J]. Shanghai Journal of Stomatology, 2021, 30(6): 658-662. doi:10.19439/j.sjos.2021.06.019
[7] Karabiber G, Yılmaz HN, Nevzato glu ?瘙塁, et al. Three-dimensional evaluation of surgically assisted asymmetric rapid maxillary expansion[J]. Am J Orthod Dentofacial Orthop, 2019, 155(5): 620-631. doi:10.1016/j.ajodo.2018.05.024
[8] Thompson L. World Health Organization classification of tumours: pathology and genetics of head and neck tumours[J]. Ear Nose Throat J, 2006, 85(2): 74
[9] 张志愿. 口腔颌面外科学[M]. 7版. 北京: 人民卫生出版社, 2012.
[10] 牛刚, 林李嵩, 吴烨, 等. 颌骨囊性病变开窗减压引流术后二次手术方法的研究与探讨[J]. 实用口腔医学杂志, 2018, 34(5): 640-643. doi:10.3969/j.issn.1001-3733.2018.05.014 NIU Gang, LIN Lisong, WU Ye, et al. Options of resurgery after decompression and suction drainage in the treatment of jaw cystic lesion[J]. Journal of Practical Stomatology, 2018, 34(5): 640-643. doi:10.3969/j.issn.1001-3733.2018.05.014
[11] Tan WL, Wong TL, Wong MC, et al. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans[J]. Clin Oral Implants Res, 2012, 23(Suppl 5): 1-21. doi:10.1111/j.1600-0501.2011.02375.x
[12] Plaza V, Del Cuvillo A, Soto-Retes L, et al. Functional endoscopic sinus surgery for nasal polyposis in asthma patients: impact on bronchial inflammation[J]. Arch Bronconeumol, 2020, 56(6): 403-405. doi:10.1016/j.arbr.2019.12.011
[13] Marin S, Kirnbauer B, Rugani P, et al. The effectiveness of decompression as initial treatment for jaw cysts: a 10-year retrospective study[J]. Med Oral Patol Oral Cir Bucal, 2019, 24(1): e47-e52. doi:10.4317/medoral.22526
[14] Slusarenko da Silva Y, Stoelinga PJW, Naclério-Homem MDG. Recurrence of nonsyndromic odontogenic keratocyst after marsupialization and delayed enucleation vs. enucleation alone: a systematic review and meta-analysis[J]. Oral Maxillofac Surg, 2019, 23(1): 1-11. doi:10.1007/s10006-018-0737-3
[15] Slusarenko da Silva Y, Stoelinga PJW, Naclério-Homem MDG. Recurrence of nonsyndromic odontogenic keratocyst after marsupialization and delayed enucleation vs. enucleation alone: a systematic review and meta-analysis[J]. Oral Maxillofac Surg, 2019, 23(1): 1-11. doi:10.1007/s10006-018-0737-3
[16] Lizio G, Ferraioli L, Melini M, et al. Long-term investigation of decompression as a definitive treatment for mandibular cysts associated with impacted third molars[J]. J Am Dent Assoc, 2018, 149(11): 953-959. doi:10.1016/j.adaj.2018.07.001
[17] Wu PW, Lee TJ, Huang CC, et al. Transnasal endoscopic marsupialization for a huge nasopalatine duct cyst with nasal involvement[J]. J Oral Maxillofac Surg, 2013, 71(5): 891-893. doi:10.1016/j.joms.2012.11.002
[18] 连冈. 鼻内镜下单纯鼻底开窗术治疗上颌骨囊肿的临床观察[J]. 临床耳鼻咽喉头颈外科杂志, 2011, 25(11): 489-490, 494. doi:10.3969/j.issn.1001-1781.2011.11.004 LIAN Gang. Treatment of maxillary cyst with endoscopic fenestration in nasal bottom[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2011, 25(11): 489-490, 494. doi:10.3969/j.issn.1001-1781.2011.11.004
[19] Seno S, Ogawa T, Shibayama M, et al. Endoscopic sinus surgery for the odontogenic maxillary cysts[J]. Rhinology, 2009, 47(3): 305-309. doi:10.4193/Rhin08.162
[20] Bosma LS, Zachiu C, Denis de Senneville B, et al. Technical note: intensity-based quality assurance criteria for deformable image registration in image-guided radiotherapy[J]. Med Phys, 2023, 50(9): 5715-5722. doi:10.1002/mp.16367
[21] Alhammadi MS, Almashraqi AA, Khadhi AH, et al. Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in borderline class III malocclusion: a systematic review[J]. Clin Oral Investig, 2022, 26(11): 6443-6455. doi:10.1007/s00784-022-04685-6
[22] 寇鹏, 李迎梅, 李志萍, 等. 3D打印改良牙支持式塞治器在下颌骨囊性病变开窗引流中的应用[J]. 上海口腔医学, 2023, 32(2): 203-208. doi:10.19439/j.sjos.2023.02.017 KOU Peng, LI Yingmei, LI Zhiping, et al. Application of 3D printing modified tooth-supported cyst plug in decompression of mandibular cystic lesions[J]. Shanghai Journal of Stomatology, 2023, 32(2): 203-208. doi:10.19439/j.sjos.2023.02.017

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