山东大学耳鼻喉眼学报 ›› 2025, Vol. 39 ›› Issue (1): 123-129.doi: 10.6040/j.issn.1673-3770.0.2023.479

• 论著 • 上一篇    

上颌骨囊肿并内翻性乳头状瘤1例并文献复习

石忠刚1,2,蔡晓岚1,3,李学忠1,3,张立强1,3,冯昕1,3   

  1. 山东大学), 山东 济南 250012
  • 发布日期:2025-01-17
  • 通讯作者: 李学忠. E-mail:lxzebyh@163.com

Maxillary cyst with inverted papilloma: a case report and literature review

SHI Zhonggang1,2, CAI Xiaolan1,3, LI Xuezhong1,3, ZHANG Liqiang1,3, FENG Xin1,3   

  1. 1. Department of Otorhinolaryngology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China2. Department of Otorhinolaryngology, JI'NAN Zhangqiu District People's Hospital, Jinan 250200, Shandong, China3. NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan 250012, Shandong, China
  • Published:2025-01-17

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摘要： 目的 探讨发生于上颌窦的鼻息肉、内翻性乳头状瘤并颌骨囊肿的临床特点、诊疗要点、手术方法。 方法 回顾性分析1例发生于上颌窦的鼻息肉、内翻性乳头状瘤及上颌骨囊肿患者病历资料,并复习相关文献进行总结。 结果 本例上颌骨囊肿合并内翻性乳头状瘤并鼻息肉的病例罕见,术中经中鼻道上颌窦自然口开放上颌窦切除鼻息肉,发现息肉位于上颌窦口前下方,上颌窦顶壁处肿物质脆、灰白色,术中快速病理证实为内翻性乳头状瘤。70°镜检查发现上颌骨骨囊肿位于上颌窦底壁,遂经泪前隐窝入路完成肿物的切除及上颌骨骨囊肿的开窗引流,术后无眶内并发症发生。 结论 针对上颌窦内翻性乳头状瘤及息肉鼻内镜外科治疗,经鼻腔入路强调术腔的开放性,经泪前隐窝入路上颌窦手术可处理传统手术难以接近的区域,有针对性的处理可彻底切除肿瘤组织,有效减少肿瘤复发。对于颌骨囊肿,采取开窗引流术可有效降低手术创伤,避免囊肿完整切除对周围重要组织结构造成的损伤,手术操作空间大,视野开阔,囊肿均得以彻底开放引流,有效减少囊肿复发,减少并发症发生,改善患者生活质量,缩短治愈时间。

关键词: 上颌窦, 鼻息肉, 内翻性乳头状瘤, 颌骨囊性病变, 鼻内镜

Abstract: Objective This study aims to investigate the clinical features, diagnosis and treatment of nasal polyps, inverting papilloma and maxillary bone cyst occurring in the maxillary sinus. Methods We retrospectively analysed the medical records of a patient with nasal polyps, inverted papilloma and maxillary bone cyst from the maxillary sinus and reviewed and summarised the relevant literature. Results This case report presents a rare occurrence of a maxillary sinus cyst combined with an inverted papilloma and a nasal polyp. During surgical excision of the nasal polyps, they were found to be located in the anterior and lower part of the maxillary sinus. In addition, a friable grey-white swelling was found on the upper wall of the maxillary sinus, which was quickly confirmed to be a varus papilloma. The maxillary cyst was also located in the inferior wall of the maxillary sinus using 70° microscopy. The maxillary cyst was fenestrated and the tumour was resected via the anterior lacrimal canal approach. There were no complications during the procedure. Conclusion For the endoscopic surgical treatment of inverted papillomas and polyps in the maxillary sinus, the nasal approach emphasises the openness of the operative cavity. In addition, surgery in the maxillary sinus through the anterior lacrimal recess can treat areas that are difficult to access through traditional surgery. Targeted treatment can completely remove tumour tissue and effectively reduce tumour recurrence. For jaw cysts, fenestration and drainage can effectively reduce surgical trauma and avoid damage to surrounding important tissue structures caused by complete cyst resection. This procedure provides a large operative space and wide field of view, allowing complete cyst drainage and reducing the risk of recurrence and complications. It can also improve patients' quality of life and reduce recovery time.

Key words: Maxillary sinus nasal polyps, Inverted papilloma, Maxillary cystic lesions, Nasal endoscopy

中图分类号: 

  • R765.4
[1] 肖水芳, 张罗, 高志强. 耳鼻咽喉头颈外科学[M]. 2版. 北京: 人民卫生出版社, 2021
[2] 华夏, 刘稳. 鼻内镜手术对鼻腔鼻窦内翻性乳头状瘤的临床疗效及预后影响分析[J]. 徐州医科大学学报, 2020, 40(8): 596-599. doi:10.3969/j.issn.2096-3882.2020.08.011 HUA Xia, LIU Wen. Clinical efficacy and prognosis of endoscopic sinus surgery for inverted papilloma of nasal cavity and paranasal sinuses[J]. Journal of Xuzhou Medical University, 2020, 40(8): 596-599. doi:10.3969/j.issn.2096-3882.2020.08.011
[3] 李幼珍, 赵侃. 鼻息肉与鼻内翻性乳头状瘤并存15例临床分析[J]. 现代实用医学, 2006, 18(10): 745-746. doi:10.3969/j.issn.1671-0800.2006.10.033 LI Youzhen, ZHAO Kan. Clinical analysis of 15 cases of nasal polyps coexisting with inverted papilloma of nose[J]. Modern Practical Medicine, 2006, 18(10): 745-746. doi:10.3969/j.issn.1671-0800.2006.10.033
[4] 高小平, 侯丽, 冯宁宇, 等. 鼻内翻性乳头状瘤伴鼻息肉的临床分析[J]. 临床耳鼻咽喉头颈外科杂志, 2012, 26(17): 781-782. doi:10.13201/j.issn.1001-1781.2012.17.006 GAO Xiaoping, HOU Li, FENG Ningyu, et al. Clinical analysis of nasal inverted papilloma complicated with nasal polyp[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2012, 26(17): 781-782. doi:10.13201/j.issn.1001-1781.2012.17.006
[5] 孙磊, 路喜安, 李正锋, 等. 内翻性乳头状瘤伴鼻息肉的病理分析[J]. 中国医药指南, 2018, 16(15): 155-156. doi:10.15912/j.cnki.gocm.2018.15.117 SUN Lei, LU Xi'an, LI Zhengfeng, et al. Pathological analysis of inverted papilloma with nasal polyps[J]. Guide of China Medicine, 2018, 16(15): 155-156. doi:10.15912/j.cnki.gocm.2018.15.117
[6] 张梅华, 张念凯, 单长胜, 等. CT对鼻腔鼻窦内翻性乳头状瘤起源的探讨[J]. 山东大学耳鼻喉眼学报, 2016, 30(1): 43-46. doi:10.6040/j.issn.1673-3770.0.2015.390 ZHANG Meihua, ZHANG Niankai, SHAN Changsheng, et al. Diagnostic value of CT of origin of nasal inverted papilloma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(1): 43-46. doi:10.6040/j.issn.1673-3770.0.2015.390
[7] 陈峰, 高下, 戴艳红, 等. 单侧鼻腔鼻窦良恶性病变并发鼻息肉25例临床分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2006, 14(1): 18-20. doi:10.16542/j.cnki.issn.1007-4856.2006.01.006 CHEN Feng, GAO Xia, DAI Yanhong, et al. Clinical analysis on 25 cases with unilateral sinonasal benign or malignant lesions complicated by nasal polyps[J]. Chinese Otorhinolaryngological Journal of Integrative Medicine, 2006, 14(1): 18-20. doi:10.16542/j.cnki.issn.1007-4856.2006.01.006
[8] Diamantopoulos II, Jones NS, Lowe J. All nasal polyps need histological examination: an audit-based appraisal of clinical practice[J]. J Laryngol Otol, 2000, 114(10): 755-759. doi:10.1258/0022215001904086
[9] 谢希翔, 刘洪斌, 万良财. 鼻内翻性乳头状瘤并发鼻息肉误诊13例分析[J]. 中国误诊学杂志, 2002, 2(5): 773. doi:10.3969/j.issn.1009-6647.2002.05.108 XIE Xixiang, LIU Hongbin, WAN Liangcai. Misdiagnosis of nasal inverted papilloma complicated with nasal polyps: an analysis of 13 cases[J]. Chinese Journal of Misdiagnostics, 2002, 2(5): 773. doi:10.3969/j.issn.1009-6647.2002.05.108
[10] Garavello W, Gaini RM. Histopathology of routine nasal polypectomy specimens: a review of 2, 147 cases[J]. Laryngoscope, 2005, 115(10): 1866-1868. doi:10.1097/01.mlg.0000177075.09594.90
[11] 刘春青. 单侧鼻息肉与鼻腔鼻窦肿瘤关系的探讨[J]. 中国中西医结合耳鼻咽喉科杂志, 2005, 13(6): 359-360. doi:10.16542/j.cnki.issn.1007-4856.2005.06.030 LIU Chunqing. Relationship between unilateral nasal polyps and nasal cavity and paranasal sinus tumors[J]. Chinese Journal of Otorhinolaryngology of Integrated Traditional and Wdstern Medicine, 2005, 13(6): 359-360. doi:10.16542/j.cnki.issn.1007-4856.2005.06.030
[12] 王建国. 单侧鼻腔鼻窦病变误诊为鼻息肉10例分析[J]. 中国误诊学杂志, 2008, 8(4): 873-874. doi:10.3969/j.issn.1009-6647.2008.04.097 WANG Jianguo. Analysis of 10 cases of unilateral nasal cavity and paranasal sinus lesions misdiagnosed as nasal polyps[J]. Chinese Journal of Misdiagnostics, 2008, 8(4): 873-874. doi:10.3969/j.issn.1009-6647.2008.04.097
[13] 孙佳, 王贵秋. 鼻内翻性乳头状瘤误诊为鼻息肉11例分析[J]. 中国误诊学杂志, 2010, 10(25): 6189 SUN Jia, WANG Guiqiu. Analysis of 11 cases of nasal inverted papilloma misdiagnosed as nasal polyps[J]. Chinese Journal of Misdiagnostics, 2010, 10(25): 6189
[14] Yaman H, Alkan N, Yilmaz S, et al. Is routine histopathological analysis of nasal polyposis specimens necessary?[J]. Eur Arch Otorhinolaryngol, 2011, 268(7): 1013-1015. doi:10.1007/s00405-011-1534-x
[15] 王鲜萍, 杨秀英. 首诊为鼻息肉的鼻腔鼻窦肿瘤16例临床分析[J]. 宁夏医学杂志, 2011, 33(3): 266-267. doi:10.13621/j.1001-5949.2011.03.046 WANG Xianping, YANG Xiuying. Clinical analysis of 16 cases of nasal cavity and paranasal sinus tumors with nasal polyps as the first diagnosis[J]. Ningxia Medical Journal, 2011, 33(3): 266-267. doi:10.13621/j.1001-5949.2011.03.046
[16] 邝少盛, 陈迪, 麦其伟. 鼻腔鼻窦内翻性乳头状瘤与鼻息肉并存的临床诊治[J]. 中国实用医药, 2013, 8(17): 114-115. doi:10.14163/j.cnki.11-5547/r.2013.17.213 KUANG Shaosheng, CHEN Di, MAI Qiwei. Clinical diagnosis and treatment of inverted papilloma and nasal polyps in nasal cavity and paranasal sinuses[J]. China Practical Medicine, 2013, 8(17): 114-115. doi:10.14163/j.cnki.11-5547/r.2013.17.213
[17] 安云崧, 刘涛, 周川, 等. 单侧鼻息肉样病变的组织病理学及临床特征分析[J]. 中国耳鼻咽喉头颈外科, 2020, 27(10): 586-588, 601. doi:10.16066/j.1672-7002.2020.10.010 AN Yunsong, LIU Tao, ZHOU Chuan, et al. Clinical presentation and pathology of unilateralnasal polyp-like lesions[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2020, 27(10): 586-588, 601. doi:10.16066/j.1672-7002.2020.10.010
[18] Edafe O, Weight G, Morsy M, et al. The incidence of significant pathology in patients presenting with benign-appearing unilateral nasal polyps[J]. J Laryngol Otol, 2022, 136(10): 998-1001. doi:10.1017/S0022215121003480
[19] 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
[20] 胡颖恺, 徐光宙, 马志贵, 等. 开窗减压术治疗大型上颌窦牙源性囊性病变疗效评价[J]. 中国口腔颌面外科杂志, 2023, 21(1): 49-54. doi:10.19438/j.cjoms.2023.01.008 HU Yingkai, XU Guangzhou, MA Zhigui, et al. Efficacy of decompression for large odontogenic maxillary sinus cysts[J]. China Journal of Oral and Maxillofacial Surgery, 2023, 21(1): 49-54. doi:10.19438/j.cjoms.2023.01.008
[21] 张罗, 韩德民, 张盛忠, 等. 鼻腔鼻窦内翻性乳头状瘤[J]. 中国耳鼻咽喉头颈外科, 2008, 15(10): 599-604. ZHANG Luo, HAN Demin, ZHANG Shengzhong, et al. Inverted papilloma of nasal cavity and paranasal sinuses[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2008, 15(10): 599-604
[22] 王广科, 史凌改, 马崧, 等. 鼻内镜下泪前隐窝入路手术治疗复发性上颌窦内翻性乳头状瘤疗效观察[J]. 中国耳鼻咽喉头颈外科, 2012, 19(5): 225-227. doi:10.16066/j.1672-7002.2012.05.016 WANG Guangke, SHI Linggai, MA Song, et al. Endoscopic anterior lacrimal recess approach for treatment of recurrent inverted papilloma of the maxillary sinus[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2012, 19(5): 225-227. doi:10.16066/j.1672-7002.2012.05.016
[23] 王颖, 蔡斌, 郑瑞, 等. 鼻内镜经泪前隐窝入路手术治疗累及上颌窦含牙囊肿[J]. 中山大学学报(医学科学版), 2015, 36(2): 317-320. doi:10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2015.0052 WANG Ying, CAI Bin, ZHENG Rui, et al. Treatment of dentigerous cyst involving maxillary sinus through the frontal recess of tears operation under endoscope[J]. Journal of Sun Yat-sen University(Medical Sciences), 2015, 36(2): 317-320. doi:10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2015.0052
[24] 周兵, 韩德民, 崔顺九, 等. 鼻内镜下鼻腔外侧壁切开上颌窦手术[J]. 中华耳鼻咽喉头颈外科杂志, 2007, 42(10): 743-748. doi:10.3760/j.issn: 1673-0860.2007.10.006 ZHOU Bing, HAN Demin, CUI Shunjiu, et al. Endoscopic nasal lateral wall dissection approach to maxillary sinus[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2007, 42(10): 743-748. doi:10.3760/j.issn: 1673-0860.2007.10.006
[25] 王明婕, 周兵, 李云川, 等. 改良泪前隐窝入路处理上颌窦良性病变的临床研究[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(24): 1847-1850. doi:10.13201/j.issn.1001-1781.2018.24.001 WANG Mingjie, ZHOU Bing, LI Yunchuan, et al. Clinical research on surgical treatment of benign lesions in maxillary sinus by modified prelacrimal duct recess approach[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(24): 1847-1850. doi:10.13201/j.issn.1001-1781.2018.24.001
[26] 冯昕, 徐丽娜, 陈文荟, 等. 改良泪前隐窝入路上颌骨囊肿开放术[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(8): 863-866. doi:10.3760/cma.j.cn115330-20201118-00875 FENG Xin, XU Lina, CHEN Wenhui, et al. Surgical treatment of maxillary bone cyst though modified endoscopic prelacrimal recess approach[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2021, 56(8): 863-866. doi:10.3760/cma.j.cn115330-20201118-00875
[27] James RH, Edward Ellis III, Myron RT. 口腔颌面外科学 [M].郑家伟,张东升,译. 上海:上海科学技术出版社, 2021
[28] Safadi A, Kleinman S, Gigi D, et al. Surgical management of odontogenic cysts involving the maxillary sinus-a retrospective study[J]. J Craniomaxillofac Surg, 2020, 48(8): 800-807. doi:10.1016/j.jcms.2020.06.011
[29] 陶谦, 兰天俊. 开窗治疗颌骨囊性病变的临床思考与循证[J]. 口腔疾病防治, 2018, 26(12): 759-765. doi:10.12016/j.issn.2096-1456.2018.12.002 TAO Qian, LAN Tianjun. Clinical thinking and evidence-based for decompression of cystic lesions in the jaw bone[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2018, 26(12): 759-765. doi:10.12016/j.issn.2096-1456.2018.12.002
[30] Castro-Núñez J. Decompression of odontogenic cystic lesions: past, present, and future[J]. J Oral Maxillofac Surg, 2016, 74(1): 104.e1-104.e9. doi:10.1016/j.joms.2015.09.004
[31] 王愿, 周涵, 刘晓静, 等. 鼻内翻性乳头状瘤的术式选择和疗效分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 79-83. doi:10.6040/j.issn.1673-3770.0.2017.441 WANG Yuan, ZHOU Han, LIU Xiaojing, et al. Surgical strategies for nasal inverted papilloma and corresponding recurrence rates[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(2): 79-83. doi:10.6040/j.issn.1673-3770.0.2017.441
[32] 赵怡芳, 刘冰. 颌骨囊性病受累牙处理的现代策略[J]. 口腔颌面外科杂志, 2019, 29(1): 1-10. doi: 10.3969/j.issn.1005-4979.2019.01.001 ZHAO Yifang, LIU Bing. Contemporary strategies for managing tooth/teeth associated with cystic lesions of the jaws[J]. Journal of Oral and Maxillofacial Surgery, 2019, 29(1): 1-10.doi: 10.3969/j.issn.1005-4979.2019.01.001
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