颌骨高流速血管畸形1例

2018-04-25 蔡传宝 雷志云 秦增辉 临床口腔医学杂志

患者,顾某,男,10岁

【一般资料】

患者,顾某,男,10岁

【主诉】

因左下后牙牙龈间断出血半年,夜间反复大出血半月就诊。

【体格检查】

颌面无明显肿胀,混合牙列,74松动Ⅱ度~Ⅲ度,73松动Ⅰ度。74、75颊侧牙龈呈肉芽样增生。

【辅助检查】

血常规未见异常;X线曲面体层片示74牙根及牙槽骨明显吸收,34近萌出。考虑73乳牙滞留,拔除后牙槽窝大量血液涌出,呈喷射状,碘仿纱布严密填塞血止。

【初步诊断

经数字化血管造影(DSA)诊断为颌骨高流速血管畸形并血管介入栓塞(图1),





【治疗】

痊愈出院,2年后复查无复发。

【讨论】

颌骨高流速血管畸形可发生于任何年龄,10~20岁多见,下颌骨较上颌骨多发,常见牙龈自发性出血(尤其是夜间)或继发频繁出血且量较多。可因乳牙松动拔牙、乳恒牙交替或误诊手术、活检而引起大出血。局部牙龈呈青紫色或暗紫红。病变可仅限于颌骨内,也可伴发周围软组织的动静脉畸形,触及波动,闻及“吹风样”杂音。X线片表现溶骨性改变,不规则、边界不清的骨质疏松区,多呈“蜂窝状”或“肥皂泡样”,骨壁变薄、膨隆;上颌窦变昏暗模糊、窦腔变大、骨壁破坏;受累牙齿移位、牙根吸收等。下颌骨动静脉血管畸形可见下牙槽神经管增粗,颏孔和下颌孔明显扩展,下颌孔呈“喇叭口”状,位置轻度下移。MRI和数字化血管造影(DSA)对其有特异性诊断意义。目前DSA和血管介入栓塞技术为颌骨高流速血管畸形治疗的首选,也包括手术、局部注射等方法。控制急性出血和预防大出血,主要通过早期诊断,分类处理,永久消灭颌骨内的异常血管团和定期随访。

原始出处:

蔡传宝, 雷志云, 秦增辉. 颌骨高流速血管畸形1例[J]. 临床口腔医学杂志, 2017, 33(2):65-65.

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    2018-04-25 有备才能无患

    颌骨高流速血管畸形可发生于任何年龄.10-20岁多见.下颌骨较上颌骨多发.常见牙龈自发性出血(尤其是夜间)或继发频繁出血且量较多.可因乳牙松动拔牙.乳恒牙交替或误诊手术.活检而引起大出血

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1709723, encodeId=ef571e09723f9, content=<a href='/topic/show?id=28e089e13d1' target=_blank style='color:#2F92EE;'>#血管畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89713, encryptionId=28e089e13d1, topicName=血管畸形)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70cd31776816, createdName=12498ca5m93暂无昵称, createdTime=Fri Jun 01 16:52:00 CST 2018, time=2018-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362229, encodeId=bf2e136222936, content=<a href='/topic/show?id=9857e03444b' target=_blank style='color:#2F92EE;'>#畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70344, encryptionId=9857e03444b, topicName=畸形)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Fri Apr 27 13:52:00 CST 2018, time=2018-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309257, encodeId=b5a230925edf, content=颌骨高流速血管畸形可发生于任何年龄.10-20岁多见.下颌骨较上颌骨多发.常见牙龈自发性出血(尤其是夜间)或继发频繁出血且量较多.可因乳牙松动拔牙.乳恒牙交替或误诊手术.活检而引起大出血, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Wed Apr 25 23:50:59 CST 2018, time=2018-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309244, encodeId=d65c30924492, content=学习了.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Wed Apr 25 22:55:55 CST 2018, time=2018-04-25, status=1, ipAttribution=)]
    2018-04-25 惠映实验室

    学习了.谢谢分享.

    0

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