口面部肉芽肿的诊治进展和临床病例报道

发布时间：2018-11-03 11:37

【摘要】：[目的]初步探讨口腔病灶在口面部肉芽肿发病及治疗中的作用,并对口面部肉芽肿的发病病因、临床表现、诊断、鉴别诊断、治疗、预后转归等相关研究进展和报道作一综述,为以后口面部肉芽肿的临床诊治提供一定参考。[方法]收集2014年7月至2017年2月在山东大学口腔医院粘膜科就诊的42例口面部肉芽肿患者,其中男性20例,女性22例,年龄为15-69岁,且均排除明显系统性疾病,如糖尿病、高血压、心脏病等。唇部肿胀者40例,其中上唇肿胀者6例,下唇肿胀者10例,双唇肿胀者7例,唇部肿胀伴有面瘫或裂舌者3例,唇部肿胀伴有唇或颊部结节样改变者12例,唇部肿胀伴有牙龈等其他部位不典型表现者2例;颊部结节样改变者2例。对此我们采取了不同的治疗方法,去除口腔病灶均取得了良好地效果。[结果]42例口面部肉芽肿患者中存在慢性根尖炎者40例,牙周炎者15例,冠周炎者4例,慢性牙髓炎者3例,其中单纯存在慢性根尖炎者20例,单纯存在牙周炎者1例,单纯存在冠周炎者1例,存在慢性根尖炎合并牙周炎者14例,存在慢性根尖炎合并冠周炎者3例,存在慢性根尖炎合并慢性牙髓炎者3例。去除口腔病灶,如根管治疗、拔除患牙、牙周治疗、必要的根尖手术等后,临床治愈者25例,症状减轻者17例,进一步治疗如应用抗组胺药、沙利度胺、局部应用他克莫司等后患者症状基本痊愈,取得了较好的临床效果。[结论]口面部肉芽肿是一种由多种病因引起的口面部的慢性肿胀和肉芽肿性炎症性疾病。它的病因不明确,可疑与遗传因素、过敏、免疫及感染因素有关,而口腔中的病灶如慢性根尖炎、牙周炎、冠周炎、慢性牙髓炎等作为重要的感染因素,对口面部肉芽肿的发生发展起着重要的作用。它的临床表现多种多样,但以唇部肿胀为特征的肉芽肿性唇炎为最常见表现。它的诊断较为复杂,仔细的临床检查、影像学辅助检查及必要的组织病理学检查可帮助口面部肉芽肿的正确诊断,需与多种系统性疾病相鉴别,如结节病、克罗恩病等。它的治疗多采取非手术治疗的方法,对因及对症治疗。对于存在明确口腔病灶的患者早期正确的诊断,尽早去除病灶,患者预后一般较好。
[Abstract]:[objective] to explore the role of oral lesions in the pathogenesis and treatment of oral and facial granuloma, and to analyze the etiology, clinical manifestations, diagnosis, differential diagnosis and treatment of oral and facial granuloma. The progress and reports of prognosis and prognosis are reviewed, which provides a reference for the clinical diagnosis and treatment of oral and facial granuloma. [methods] from July 2014 to February 2017, 42 patients with oral and facial granulomatosis were collected, including 20 males and 22 females, aged 15-69 years, all of whom were excluded from obvious systemic diseases. Such as diabetes, high blood pressure, heart disease and so on. There were 40 cases of lip swelling, including 6 cases of upper lip swelling, 10 cases of lower lip swelling, 7 cases of double lip swelling, 3 cases of lip swelling with facial paralysis or fissure of tongue, 12 cases of lip swelling with nodular changes of lip or buccal region. There were 2 cases of labial swelling accompanied by atypical manifestations of other parts such as gingiva. Nodular changes in the buccal region were found in 2 cases. We have adopted different treatment methods and achieved good results in removing oral lesions. [results] there were 40 cases of chronic apical inflammation, 15 cases of periodontitis, 4 cases of pericoronitis and 3 cases of chronic pulpitis in 42 patients with oral and facial granuloma. There were only 1 case of pericoronitis, 14 cases of chronic apical periodontitis, 3 cases of chronic apical periodontitis and periodontitis, 3 cases of chronic apical periodontitis and chronic pulpitis. After removal of oral lesions, such as root canal therapy, extraction of teeth, periodontal treatment and necessary apical surgery, 25 cases were clinically cured and 17 cases were relieved of symptoms. Further treatment such as antihistamine, thalidomide, etc. After local application of tacrolimus, the symptoms of the patients were basically cured and good clinical results were obtained. Conclusion Oral and facial granuloma is a chronic swelling and granulomatous inflammatory disease caused by many causes. The etiology of the disease is not clear, and is suspected to be related to genetic factors, allergies, immunity and infection, while oral lesions such as chronic apical periodontitis, pericoronitis, chronic pulpitis, etc., are important infectious factors. The occurrence and development of facial granuloma plays an important role. Its clinical manifestations are varied, but granulomatous lipitis characterized by swelling of the lip is the most common manifestation. Its diagnosis is more complicated. Careful clinical examination, imaging auxiliary examination and necessary histopathological examination can help the correct diagnosis of oral and facial granuloma, and should be distinguished from many systemic diseases, such as sarcoidosis, Crohn's disease, etc. Its treatment takes the method of non-surgical treatment, for the cause and symptomatic treatment. For patients with definite oral lesions, early diagnosis and early removal of lesions, the prognosis of patients is generally good.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R758.6

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